Cardiology · Medical Literature
The impact of home-based telerehabilitation versus center-based cardiac rehabilitation on anxiety, depression, and quality of life after coronary artery bypass grafting: a randomized controlled trial.
Abstract
BACKGROUND: Anxiety, depression, and reduced quality of life are common after coronary artery bypass grafting (CABG), yet participation in traditional center-based cardiac rehabilitation (CBCR) is limited by access barriers. This study aims to compare the effectiveness of a home-based telerehabilitation (HBTCR) program with CBCR in improving psychological and quality-of-life outcomes for post-CABG patients. METHODS: In this prospective randomized controlled trial, 110 clinically stable patients 4–8 weeks post-CABG were allocated to a 12-week HBTCR program (wearable monitoring, mobile app, weekly nurse support), CBCR (supervised center sessions), or usual care. Primary outcomes were changes in Hamilton Anxiety (HAMA) and Depression (HAMD-17) scores. The secondary outcome was change in health-related quality of life (SF-36). RESULTS: Both HBTCR and CBCR groups demonstrated significant and comparable improvements compared to usual care (mean HAMA change: -8.3 vs. -7.9 vs. -1.1, P < 0.001; HAMD-17: -9.5 vs. -9.1 vs. -1.5, P < 0.001). No significant difference was found between HBTCR and CBCR. Quality of life improved significantly across all SF-36 domains in both intervention groups versus control (P < 0.01). CONCLUSIONS: A structured home-based telerehabilitation program is as effective as traditional center-based rehabilitation in alleviating psychological distress and enhancing quality of life after CABG. HBTCR represents a vital, accessible alternative to deliver comprehensive cardiac rehabilitation and overcome participation barriers. TRIAL REGISTRATION: This trial was retrospectively registered at ClinicalTrials.gov (identifier: NCT07232693, Registration date: 2025-11-14).
Clinical relevance
In clinically stable patients 4–8 weeks after coronary artery bypass grafting (CABG), is a 12-week home-based telerehabilitation (HBTCR) program—using wearable monitoring, a mobile application, and weekly nurse support—as effective as traditional center-based cardiac rehabilitation (CBCR) in reducing anxiety and depression and improving health-related quality of life? __SNAPSHOT__ {"studyDesign":"Prospective, three-arm randomized controlled trial","setting":"Not reported (single center implied by trial design; country not specified in abstract)","sampleSize":"n=110 total; three arms: HBTCR, CBCR, and usual care (per-arm n not reported in abstract)","population":"Clinically stable adult patients 4–8 weeks post-CABG; detailed inclusion/exclusion criteria not reported in abstract","intervention":"12-week home-based telerehabilitation (HBTCR) program comprising wearable physiologic monitoring, a mobile application, and weekly nurse support contacts","comparator":"Center-based cardiac rehabilitation (CBCR; supervised center sessions) and usual care (control arm)","primaryOutcome":"Change from baseline in Hamilton Anxiety Rating Scale (HAMA) score and Hamilton Depression Rating Scale–17 item (HAMD-17) score at 12 weeks","followUp":"12 weeks (duration of intervention); post-intervention follow-up beyond 12 weeks not reported","fundingSource":"Not reported"}
Key findings
Both active rehabilitation arms produced statistically significant and clinically large reductions in anxiety and depression scores compared with usual care. Mean HAMA score change: HBTCR −8.3 vs. CBCR −7.9 vs. usual care −1.1 (P < 0.001 for both active arms vs. usual care). Mean HAMD-17 score change: HBTCR −9.5 vs. CBCR −9.1 vs. usual care −1.5 (P < 0.001 for both active arms vs. usual care). No statistically significant difference was detected between HBTCR and CBCR for either primary outcome, consistent with non-inferiority of the telerehabilitation approach, though the study was not explicitly designed or powered as a formal non-inferiority trial (not reported). The between-group difference for HAMA (HBTCR vs. CBCR) was −0.4 points (calculated) and for HAMD-17 was −0.4 points (calculated); confidence intervals and p-values for the HBTCR-vs.-CBCR comparison are not reported in the abstract. Health-related quality of life (SF-36) improved significantly across all domains in both active rehabilitation groups compared with usual care; domain-level effect sizes, confidence intervals, and p-values are not reported due to abstract truncation. NNT cannot be calculated because no dichotomous response threshold was defined. Adverse event data are not reported in the available abstract.
Practice implications
This trial establishes that both HBTCR and CBCR produce substantial improvements in post-CABG anxiety, depression, and health-related quality of life over 12 weeks, with neither modality demonstrating statistical superiority over the other. The magnitude of change in HAMA (approximately −8 points) and HAMD-17 (approximately −9.5 points) in both active arms, compared with minimal change in usual care (−1.1 and −1.5 points, respectively), suggests clinical as well as statistical significance, though formal minimal clinically important difference (MCID) analyses are not reported. The findings are most applicable to clinically stable post-CABG patients who can engage with digital health platforms; patients with significant comorbidities, low digital literacy, frailty, advanced age, or limited device access were not explicitly described and may not be adequately represented. The trial does not establish non-inferiority by formal pre-specified margin, so equivalence between arms should be interpreted cautiously. The study was not designed to assess effects on hard cardiovascular outcomes (mortality, rehospitalization, MACE), exercise capacity, or long-term (>12 weeks) durability of benefit. IMPORTANT LIMITATION: Only the abstract was available; the SF-36 results section is truncated, and domain-level data, confidence intervals, adherence rates, adverse events, and allocation details cannot be assessed. Practice should not change on the basis of this single trial alone, but results align with and extend the existing evidence base supporting home-based cardiac telerehabilitation as a viable alternative to center-based programs for psychological outcomes. __LIMITATIONS__ Abstract truncation: SF-36 domain results, confidence intervals for between-group comparisons, adverse event data, and full statistical reporting are unavailable; review is restricted to abstract only.,Relatively small sample size (n=110 across three arms) limits power for subgroup analyses and precision of effect estimates.,Follow-up limited to 12 weeks; durability of psychological and quality-of-life benefits beyond the intervention period is unknown.,Formal non-inferiority design and pre-specified non-inferiority margin are not reported; the null finding for HBTCR vs. CBCR cannot be interpreted as proven equivalence.,Setting and country not reported, limiting assessment of generalizability; a significant proportion of cardiac telerehabilitation RCTs originate from China, where healthcare delivery models and digital infrastructure may differ from Western settings.,Blinding of participants to treatment allocation is not feasible in rehabilitation trials; assessor blinding status is not reported.,Per-arm sample sizes not reported; balance of allocation cannot be confirmed.,Usual care arm content is not defined; contamination or co-interventions cannot be assessed.,Patient characteristics (age, sex, comorbidities, baseline psychiatric status, digital literacy) are not described in the abstract, limiting assessment of selection bias and external validity.,Adherence rates and dropout are not reported, which are critical for interpreting telerehabilitation efficacy in real-world practice.,No hard clinical outcomes (mortality, rehospitalization, MACE) assessed; reliance on patient-reported and psychometric endpoints only.,Funding source not reported; potential conflicts of interest cannot be evaluated. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ In this three-arm RCT of 110 post-CABG patients, both 12-week home-based telerehabilitation (HBTCR) and center-based cardiac rehabilitation (CBCR) produced large, statistically significant improvements in anxiety, depression (HAMA, HAMD-17), and quality of life (SF-36) compared with usual care, with no significant difference between the two active modalities. These findings suggest HBTCR is a clinically viable alternative to CBCR for post-CABG psychological recovery, particularly for patients facing access barriers to center-based programs. Confirmation in larger, formally powered non-inferiority trials with longer follow-up, hard clinical endpoints, and diverse patient populations is needed before broad practice change is warranted.