A Cochrane review included 18 studies (2505 participants), 10 studies (1338 participants) of interventions to improve uptake of cardiac rehabilitation and eight studies (1167 participants) of interventions to increase adherence. Meta-analysis was not possible due to multiple sources of heterogeneity. Eight of 10 studies demonstrated increased uptake of cardiac rehabilitation. Successful interventions to improve uptake of cardiac rehabilitation included: structured nurse- or therapist-led contacts, early appointments after discharge, motivational letters, gender-specific programs, and intermediate phase programs for older patients. Three of eight studies demonstrated improvement in adherence to cardiac rehabilitation. Successful interventions included: self monitoring of activity, action planning, and tailored counselling by cardiac rehabilitation staff. Data were limited on mortality and morbidity but did not demonstrate a difference in cardiovascular events or mortality except for one study that noted an increased rate of revascularization in the intervention group. None of the studies found a difference in health-related quality of life and there was no evidence of adverse events. No studies reported on costs or healthcare utilization.
The interventions to improve uptake included motivational letters, motivational telephone contact and home visits, and co-ordination of care by a trained nurse, together with patient self-monitoring of contact with health professionals. In all 3 studies attendance was significantly higher in the group receiving the intervention. Attendance in the intervention groups ranged from 42 to 86%. Percentage difference in attendance between intervention and comparison groups ranged from 18 to 30%. Only one study reported data for any of the secondary outcomes; serum cholesterol, blood pressure and smoking status did not differ between groups.Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding) and by inconsistency (heterogeneity in interventions and outcomes).