Cardiology · Medical Literature
Effect of home-based cardiac rehabilitation on quality of life, health behaviours and cardiac anxiety in patients with coronary artery disease: findings from a single-blinded randomised controlled trial.
Abstract
To evaluate the effectiveness of a contextually developed home-based cardiac rehabilitation (HBCR) programme on heart-related quality of life (QoL), cardiac health behaviours (CHB) and cardiac anxiety (CA) among patients with coronary artery disease (CAD) in Lahore, Pakistan. Single-blinded randomised controlled trial (RCT). Cardiology department of a public tertiary-care hospital in Lahore, Pakistan. 120 patients aged 18-65 years diagnosed with coronary artery disease who had undergone percutaneous coronary intervention or medical management were recruited and randomly allocated to intervention (n=60) and control (n=60) groups. Participants in the intervention group received a nurse-led HBCR programme consisting of discharge education, structured physical activity and exercise guidance, dietary counselling, medication adherence support, and regular telephonic and physical follow-ups over 24 weeks. The control group received routine care and standard discharge advice. Primary outcomes were heart-related quality of life (MacNew HRQoL), cardiac health behaviours (Cardiac Health Behaviour Scale-21) and cardiac anxiety (Cardiac Anxiety Questionnaire-18), assessed at baseline, 3 months and 6 months postdischarge. At 6-month follow-up, the intervention group demonstrated significantly higher global QoL scores compared with the control group (mean difference 30.71, 95% CI 22.90 to 38.50). CHB scores were also significantly higher in the intervention group (mean difference 19.60, 95% CI 16.20 to 23.00). CA scores were significantly lower among participants receiving HBCR (mean difference -18.72, 95% CI -21.00 to -16.40). These improvements were evident after 3 months and sustained at 6 months. The nurse-led HBCR programme significantly improved QoL and CHB and reduced CA among patients with CAD. HBCR may provide an effective and scalable secondary prevention strategy in settings where centre-based cardiac rehabilitation services are limited. Australian New Zealand Clinical Trial Registry, ACTRN12623000049673p.
Clinical relevance
In adults with coronary artery disease in a low-resource Pakistani setting, does a nurse-led, contextually developed home-based cardiac rehabilitation (HBCR) programme improve heart-related quality of life, cardiac health behaviours, and cardiac anxiety compared with routine care at 6 months? __SNAPSHOT__ {"studyDesign":"Single-blinded randomised controlled trial (RCT)","setting":"Cardiology department of a public tertiary-care hospital (Mayo Hospital) in Lahore, Pakistan — a setting without established centre-based cardiac rehabilitation services","sampleSize":"n = 120 (intervention: n = 60; control: n = 60)","population":"Adults aged 18–65 years with a diagnosis of coronary artery disease who had undergone percutaneous coronary intervention (PCI) or were managed medically; recruited at hospital discharge","intervention":"Nurse-led HBCR programme comprising discharge education, structured physical activity and exercise guidance, dietary counselling, medication adherence support, and regular telephonic and in-person follow-ups delivered over 24 weeks","comparator":"Routine care plus standard discharge advice","primaryOutcome":"Three co-primary outcomes assessed at baseline, 3 months, and 6 months post-discharge: (1) heart-related quality of life (MacNew HRQoL); (2) cardiac health behaviours (Cardiac Health Behaviour Scale-21, CHBS-21); (3) cardiac anxiety (Cardiac Anxiety Questionnaire-18, CAQ-18)","followUp":"6 months post-discharge (with interim assessment at 3 months)","fundingSource":"Not reported"}
Key findings
At the 6-month follow-up, the HBCR group demonstrated significantly higher global heart-related quality of life scores than controls (mean difference [MD] +30.71, 95% CI 22.90 to 38.50; p-value not reported in abstract). Cardiac health behaviour scores were also significantly higher in the intervention group (MD +19.60, 95% CI 16.20 to 23.00; p-value not reported). Cardiac anxiety scores were significantly lower in the HBCR group (MD −18.72, 95% CI −21.00 to −16.40; p-value not reported). All three outcome improvements were evident at the 3-month interim assessment and were sustained at 6 months. The absolute scale ranges for MacNew HRQoL, CHBS-21, and CAQ-18 are not reported in the available abstract, precluding calculation of standardised effect sizes or NNT/NNH. No adverse events, safety data, or between-group attrition data were reported in the abstract. Funding source was not reported.
Practice implications
This RCT provides evidence that a structured, nurse-led HBCR programme — incorporating education, exercise, dietary counselling, and medication adherence support — is superior to routine care alone for improving quality of life, health behaviours, and cardiac anxiety in CAD patients in a setting where centre-based rehabilitation is unavailable. The magnitude of the reported mean differences appears large in absolute terms, though clinical importance cannot be fully assessed without knowledge of each instrument's full score range, published minimal clinically important difference (MCID) thresholds for these specific tools, and baseline group values — none of which are available from the abstract alone. Findings apply most directly to CAD patients (post-PCI or medically managed) aged 18–65 years in urban, low-resource South Asian settings. Generalisability to high-income countries with established cardiac rehabilitation infrastructure, to patients over 65, to those with recent acute myocardial infarction or heart failure, or to populations with differing cultural and logistical contexts is uncertain. The study did not assess hard clinical endpoints (mortality, recurrent MI, rehospitalisation, or exercise capacity). Single-blinding (participant blinding was not feasible given the nature of the intervention) introduces performance and detection bias risk. Whether these improvements translate to reduced major adverse cardiac events or long-term mortality remains unestablished. IMPORTANT LIMITATION NOTE: This summary is based solely on the published abstract; full text review is strongly recommended before clinical decision-making. __LIMITATIONS__ Small sample size (n = 120) limits precision and power to detect subgroup effects or rare harms.,Single-blinding: participants could not be blinded to treatment allocation, risking performance and detection bias in self-reported outcomes.,All three primary outcomes are patient-reported instruments; no objective measures (e.g., exercise capacity, biomarkers, event rates) were reported in the abstract.,The control is routine care without any active cardiac rehabilitation, creating a high-contrast comparator that may overestimate the benefit of HBCR versus structured but conventional centre-based rehabilitation.,Single-centre, single-country study conducted in a public tertiary hospital in Lahore; results may not generalise to other healthcare systems, rural settings, or higher-income countries.,No hard clinical outcomes (mortality, recurrent MI, hospitalisation) were reported; improvements in QoL and anxiety are important but surrogate in nature.,Funding source is not reported, limiting assessment of potential conflicts of interest.,The abstract truncates at the 3-month assessment description; full statistical reporting (p-values, baseline means, attrition rates, intention-to-treat vs. per-protocol analysis) is available only in the full text.,Unclear whether the HBCR programme components (nurse training, telephonic follow-up infrastructure, culturally adapted tools) are replicable in other resource-limited settings outside Pakistan.,Six-month follow-up does not capture long-term durability of behavioural and QoL gains. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ In CAD patients managed in a public hospital in Pakistan without access to centre-based cardiac rehabilitation, a 24-week nurse-led HBCR programme significantly improved quality of life and cardiac health behaviours while reducing cardiac anxiety at 6 months compared with routine care. Effect sizes appear large, but clinical importance relative to established MCIDs and generalisability to other health systems require full-text verification and replication in larger, multisite trials. This study is potentially practice-informing for clinicians in low- and middle-income settings where centre-based rehabilitation is unavailable, but should not independently change practice in settings with established rehabilitation infrastructure.