Review
Cardiac rehabilitation and quality of life: A systematic review

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Abstract

Objective

The objective of this systematic review was to explore the effects of cardiac rehabilitation interventions on the quality of life of patients with coronary heart disease with a specific focus on interventions that could be delivered within the context of a publicly funded health service.

Design

Systematic review of trials reporting quality of life data as an outcome measure. Electronic databases (CINAHL, MEDLINE and PsycINFO) were searched from 1 January 1999 to 25 November 2010 in the English language. Inclusion criteria were: randomised controlled trials of cardiac rehabilitation as configured for a publicly funded health service. Data were extracted by one reviewer and checked by a second reviewer.

Results

The 16 papers reported RCTs conducted in nine countries. Fifteen measurement instruments were utilised to measure quality of life across the different studies precluding a meta-analysis. Four themes emerged from the thematic analysis of the selected papers: physical well-being (including fitness and symptoms); psychological well-being (including anxiety and depression); social well-being (including family life and relationships); and functional status (including return to work and previous life style). Physical domain outcomes suggest that cardiac rehabilitation may improve physical well-being and levels of physical activity and thereby improved levels of physical fitness. Both physical and psychological domain outcomes suggest that home-based interventions are at least as effective as centre-based interventions. Relatively few trials reported on quality of life within the social domain and any difference between centre-based and home-based interventions appeared to favour the home-based intervention.

Conclusions

This review indicates that cardiac rehabilitation improves the quality of life for coronary heart disease patients and that quality of life improvements have a bi-directional relationship with increased physical activity and vocational status. Further research is needed to explore the relationship of quality of life outcomes to cardiac mortality, the relationship between improved physical well-being and anxiety, and the quality of life and mortality effects of cardiac rehabilitation in older people.

Section snippets

Background

The ageing population presents challenges to national healthcare systems as they deal with rising health and social care costs (World Health Organization, WHO, 2005). Coronary heart disease (CHD) is a long term condition for which age is an independent risk factor (Joint British Societies, 2005). Cardiac rehabilitation is a cost effective intervention for CHD that improves functional capacity and quality of life and furthermore has been shown to reduce acute hospital admissions (Hedback et al.,

Aims and objectives

The review aimed to explore the effects of cardiac rehabilitation interventions on the QoL of patients with CHD with a specific focus on interventions that could be delivered within the context of a publicly funded health service. A search of the Cochrane library identified two systematic reviews of cardiac rehabilitation. The papers considered for each review included these years: Jolliffe et al. (2001) 1972–1999 (trials n = 51); and Rees et al. (2004) 1974–2001 (trials n = 36). QoL outcomes were

Findings

The 16 papers reported RCTs conducted in nine countries (Australia, Brazil, Canada, Finland, Italy, Japan, Norway, Sweden and UK). Three trials are represented by more than one paper and were included because they reported different QoL data. Eight studies: Arthur et al. (2002), Briffa et al. (2005), Lie et al. (2009), Marchionni et al. (2003), Smith et al. (2004), Dalal et al. (2007), Hanssen et al. (2007) and Jolly et al. (2007) reported a power calculation as a basis for sample size and

Discussion

The limitations of this review include the use of three databases and English language papers only. No attempt was made to include the grey literature. The starting point of this literature review was two Cochrane reviews of cardiac rehabilitation (Jolliffe et al., 2001, Rees et al., 2004) which reported contrasting results with psychological interventions not yielding mortality benefits while interventions with an exercise component yielded substantial mortality benefits. These findings

Conclusion

This review indicates that cardiac rehabilitation improves the QoL for CHD patients and that QoL improvements have a bi-directional relationship with increased physical activity and vocational status, which, in turn further improve QoL and may reduce mortality. Home-based programmes offer the opportunity to give patients more choice and may be particularly useful in improving uptake among older CHD patients who are most sensitive to the benefits of cardiac rehabilitation.

Moreover, for nurses

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