Telemedicine-based exercise cardiac rehabilitation shows comparable effects to center-based programs for coronary heart disease patients.

This systematic review and meta-analysis evaluated the effectiveness of personalized structured telemedicine-based exercise cardiac rehabilitation (exCR) for patients with coronary heart disease. The study included 2219 patients, though the specific setting was not reported. The intervention involved telemedicine-based exCR, which was compared to two groups: center-based exCR and usual care. The telemedicine approach was described as personalized and structured, but details on dosing, protocol specifics, or duration were not provided. The comparator groups included standard center-based exCR programs and usual care, which typically involves routine medical management without structured exercise rehabilitation.

The primary outcome was exercise capacity. When compared to center-based exCR, telemedicine exCR showed comparable effects, with no significant difference (P > 0.05). The effect size was not reported in absolute numbers, and the direction was not specified. In contrast, compared to usual care, telemedicine exCR resulted in a significant improvement in exercise capacity, with a standardized mean difference (SMD) of 0.23 (95% CI: 0.12 to 0.35, P < 0.0001) and low heterogeneity (I2 = 34%). This indicates a small to moderate benefit over usual care.

Key secondary outcomes were also assessed. Compared to center-based exCR, telemedicine exCR had comparable effects on physical activity levels (P > 0.05), cardiovascular risk factors (P > 0.05), and quality of life (P > 0.05), with no significant differences. Versus usual care, telemedicine exCR significantly improved physical activity levels (SMD = 0.32, 95% CI: 0.09 to 0.54, P = 0.006, I2 = 53%), diastolic blood pressure (mean difference = -1.54, 95% CI: -2.89 to -0.20, P = 0.02, I2 = 8%), body mass index (mean difference = -0.54, 95% CI: -1.94 to -0.14, P = 0.008, I2 = 4%), and depression (SMD = -0.27, 95% CI: -0.42 to -0.13, P = 0.0002, I2 = 33%). These improvements suggest telemedicine exCR may offer broader health benefits beyond exercise capacity alone.

Safety and tolerability findings were limited, as adverse events, serious adverse events, discontinuations, and tolerability were not reported in the input. This absence of data precludes any conclusions about the safety profile of telemedicine exCR compared to center-based exCR or usual care, highlighting a critical gap in the evidence.

In comparison to prior landmark studies in cardiac rehabilitation, this meta-analysis suggests telemedicine exCR may be a viable alternative to traditional center-based programs, with similar effectiveness on key outcomes. However, without direct head-to-head trials or long-term data, it is unclear how these results align with established guidelines or previous research on exCR modalities. The findings support the potential of telemedicine to expand access to rehabilitation, but they do not establish superiority over existing methods.

Key methodological limitations include the observational nature of the meta-analysis, which relies on aggregated data from potentially heterogeneous studies, limiting causal inferences. The input did not specify limitations, but common issues in such analyses may include variability in telemedicine protocols, lack of blinding, and potential publication bias. The absence of safety data and detailed intervention protocols further restricts the interpretability and generalizability of the results.

Clinical implications suggest that telemedicine-based exCR could be considered as an option for coronary heart disease patients, particularly when center-based programs are inaccessible. It may offer comparable benefits to traditional exCR and improvements over usual care in multiple domains. However, decisions should be individualized, considering patient preferences, technological access, and the lack of safety information. Further research is needed to optimize telemedicine protocols and assess long-term outcomes.

Unanswered questions include the long-term efficacy and safety of telemedicine exCR, optimal dosing and structure of telemedicine interventions, cost-effectiveness compared to center-based exCR, and impact on hard clinical endpoints like mortality or hospitalizations. Additionally, the role of telemedicine in diverse patient populations and settings remains unexplored, warranting more rigorous randomized controlled trials to address these gaps.