Updated Cochrane Analysis Finds Stronger Evidence for Cardiac Rehabilitation Across Diverse Populations

An updated Cochrane review of 107 trials involving nearly 27,000 adults with coronary heart disease found that exercise-based cardiac rehabilitation reduced heart attacks and hospital admissions in the short term, and lowered cardiovascular mortality and heart attack risk over longer follow-up. The evidence now includes more women and participants from low- and middle-income countries, supporting both home-based and center-based programs as part of integrated care.

The updated review incorporates 22 additional trials since the 2021 version, expanding the evidence base from 85 to 107 studies. Notably, the short-term all-cause mortality benefit reached statistical significance for the first time, though the authors acknowledge that modern medical treatments may limit additional mortality gains. The inclusion of digital and home-based programs represents a significant shift, potentially expanding access for patients who cannot attend traditional center-based rehabilitation.

The review's strengthened evidence base now includes greater representation from women and participants in low- and middle-income countries, addressing previous generalizability concerns. Cost-effectiveness and quality-of-life measures consistently favored cardiac rehabilitation. The authors emphasize that exercise-based rehabilitation should complement, not replace, contemporary invasive procedures and pharmacological therapy as part of integrated coronary heart disease care.