Article type
Abstract
Background: Cardiac rehabilitation (CR) is essential for secondary prevention in heart conditions, improving physical and mental health, and prognosis. Despite its benefits, access to traditional hospital-based CR is often limited, especially for women, older individuals, and ethnic minorities. Therefore, there is a need to explore alternative delivery methods for CR.
Objectives: To synthesize the available evidence on the effectiveness and safety of out-of-hospital CR for ischemic heart disease or heart failure within a Health Technology Assessment (HTA) process aimed at informing the Spanish National Health System. Given the evolving evidence base, a Living Evidence Synthesis (LES) was proposed to maintain up-to-date estimates of the effects as new data becomes available.
Methods: The methodology included an initial baseline synthesis assessing the impact of out-of-hospital CR on mortality, cardiac events, cardiovascular risk factors, quality of life, affective symptoms, and adverse events. Based on its findings, evidence monitoring was planned for 12 months, starting August 30, 2023, following the Living Evidence to Inform Health Decisions (LE-IHD) framework and using the GRADE approach. The process of evidence identification, screening, and selection was supported by Epistemonikos’s technological enablers and its Living Overview of Evidence (L.OVE) platform. Whenever a new eligible study emerged, we followed a systematic and reproducible process for its incorporation or postponement in meta-analysis. The evidence synthesis was updated accordingly, with periodic reviews conducted to maintain its relevance and reliability.
Results: The baseline synthesis of 26 randomized controlled trials suggested that out-of-hospital CR might be equivalent to hospital-based CR in various health outcomes, despite the evidence ranging from very-low to low-quality. Since the initiation of evidence monitoring, two additional studies were identified. However, their impact was likely minimal, not affecting the initial results' direction or magnitude, leading to the postponement of their inclusion in the meta-analysis. Any substantial changes in evidence will be integrated in the 12-month update.
Conclusions: HTA processes based on low-quality evidence could significantly benefit from the LES approach, ensuring timely updates and enhancing their utility in decision-making. The LE-IHD framework facilitates effective planning and implementation of LES, ensuring that health decisions are informed by the most current evidence.
Objectives: To synthesize the available evidence on the effectiveness and safety of out-of-hospital CR for ischemic heart disease or heart failure within a Health Technology Assessment (HTA) process aimed at informing the Spanish National Health System. Given the evolving evidence base, a Living Evidence Synthesis (LES) was proposed to maintain up-to-date estimates of the effects as new data becomes available.
Methods: The methodology included an initial baseline synthesis assessing the impact of out-of-hospital CR on mortality, cardiac events, cardiovascular risk factors, quality of life, affective symptoms, and adverse events. Based on its findings, evidence monitoring was planned for 12 months, starting August 30, 2023, following the Living Evidence to Inform Health Decisions (LE-IHD) framework and using the GRADE approach. The process of evidence identification, screening, and selection was supported by Epistemonikos’s technological enablers and its Living Overview of Evidence (L.OVE) platform. Whenever a new eligible study emerged, we followed a systematic and reproducible process for its incorporation or postponement in meta-analysis. The evidence synthesis was updated accordingly, with periodic reviews conducted to maintain its relevance and reliability.
Results: The baseline synthesis of 26 randomized controlled trials suggested that out-of-hospital CR might be equivalent to hospital-based CR in various health outcomes, despite the evidence ranging from very-low to low-quality. Since the initiation of evidence monitoring, two additional studies were identified. However, their impact was likely minimal, not affecting the initial results' direction or magnitude, leading to the postponement of their inclusion in the meta-analysis. Any substantial changes in evidence will be integrated in the 12-month update.
Conclusions: HTA processes based on low-quality evidence could significantly benefit from the LES approach, ensuring timely updates and enhancing their utility in decision-making. The LE-IHD framework facilitates effective planning and implementation of LES, ensuring that health decisions are informed by the most current evidence.