Effects of Remote, Virtual, or Hybrid Cardiac Rehabilitation Supported by mHealth in Patients With Heart Failure: A Systematic Review and Meta-Analysis (Preprint)
Bibliographic record
Abstract
Background: Structured exercise is a key component of cardiac rehabilitation (CR) for patients with heart failure (HF), but access to center-based cardiac rehabilitation (CBCR) is often limited. Mobile health (mHealth) platforms enable remote, virtual, or hybrid cardiac rehabilitation (RVH-CR) delivery. Objective: This study aimed to evaluate the effectiveness and safety of structured, exercise-focused RVH-CR supported by mHealth compared with usual care or CBCR in patients with heart failure with reduced ejection fraction (HFrEF) or in HF populations predominantly comprising patients with HFrEF. Methods: We searched PubMed, Web of Science, MEDLINE via Ovid, Cochrane CENTRAL, and CINAHL Complete from inception to April 27, 2026. Randomized controlled trials comparing mHealth-supported RVH-CR with usual care or CBCR were included. The primary outcome was exercise capacity, assessed by peak oxygen uptake (VO2 peak) and 6-minute walk distance (6MWD). Secondary outcomes included health-related quality of life and safety. Data were pooled using random-effects meta-analysis stratified by comparator. Risk of bias was assessed with the Cochrane Risk of Bias Tool version 2, and evidence certainty was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results: Eight randomized controlled trials with 1368 patients were included. In the CBCR comparison, mHealth-supported RVH-CR showed a statistically significant greater improvement in VO2 peak than CBCR (mean difference [MD] 0.82, 95% CI 0.06-1.57; P=.03), although this finding was based on a limited number of trials. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD (MD 22.99, 95% CI 1.15-44.82; P=.04). Single-trial estimates suggested improvements in VO2 peak (MD 2.50, 95% CI 0.88-4.12) and Minnesota Living with Heart Failure Questionnaire scores (standardized MD -0.57, 95% CI -0.98 to -0.17; P<.01) versus usual care. The certainty of evidence ranged from low to moderate. No intervention-related deaths or serious adverse events were reported, but sparse events and short follow-up limited conclusions regarding safety. Conclusions: The effects of structured RVH-CR supported by mHealth differed according to comparator type, but the certainty of evidence ranged from low to moderate. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD. Compared with CBCR, mHealth-supported RVH-CR showed a significantly greater improvement in VO2 peak in a limited number of trials, but superiority, equivalence, or noninferiority to CBCR cannot be concluded. Because usual care and CBCR are clinically distinct comparators, no single overall effect across comparator types should be inferred. Future studies should assess long-term outcomes and standardize structured exercise protocols across RVH-CR models.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.017 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.034 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".