Effectiveness of quality improvement interventions in cardiac rehabilitation on processes and patient outcomes: a systematic review and meta-analysis.

Sanuri Wijesekera Kankanamge, Robyn Gallagher, Sherry L Grace, Ling Zhang, Michelle Cunich, Dion Candelaria

Abstract readSystematic ReviewMeta-Analysis

In one paragraph

Synthesis in European heart journal. Quality of care & clinical outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it

0cells of the map it votes in

1citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

Comparisons of core component delivery in cardiac rehabilitation programs by country income classification and decade based on the 2025 Global Audit Update: A survey study.PLoS medicine · 2026
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Sanuri Wijesekera KankanamgeFaculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales 2006, Australia.ORCID 0009-0008-5428-501X

Robyn GallagherFaculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales 2006, Australia.ORCID 0000-0001-5588-9351

Sherry L GraceFaculty of Health, School of Kinesiology and Health Science, York University, North York, Ontario, Canada M3J 1P3.ORCID 0000-0001-7063-3610

Ling ZhangFaculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales 2006, Australia.ORCID 0000-0002-9961-2079

Michelle CunichFaculty of Medicine and Health, Boden Initiative, Charles Perkins Centre, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia.

Dion CandelariaFaculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales 2006, Australia.ORCID 0000-0001-7547-2860

Funding

Australian Government National Health and Medical Research CouncilMedical Research Future Fund ID: App201617National Heart Foundation of Australia

6 · The paper itself

Abstract

aimsSignificant variability in cardiac rehabilitation (CR) programme content and delivery persists. Quality improvement interventions enhance adherence to standards and reduce variability, yet synthesized evidence of their characteristics and effectiveness in CR is lacking. This meta-analysis aimed to evaluate the effects of quality improvement interventions on CR processes and patient outcomes. METHODS AND

resultsScopus, CENTRAL, Medline, Embase, and CINAHL were searched for studies published from January 2000 to November 2024. Study selection in Covidence, data extraction, and risk of bias assessment were completed. Where possible, meta-analyses were conducted using RevMan v5.3, random-effects model. Outcomes not suitable for meta-analysis were reported narratively. Fifteen studies (76 856 participants) were eligible, including 1 randomized controlled trial, 1 retrospective observational study, and 13 pre-post studies. Meta-analysis of 11 studies (17 010 participants) showed that quality improvement interventions significantly improved CR referral [odds ratio (OR) 5.25; 95% confidence interval (CI) 3.11, 8.87]. From subgroup analyses, patient education had the largest effect (OR 8.37; 95% CI 4.32, 16.21), followed by technology (OR 5.56; 95% CI 2.67, 11.58) and process changes (OR 5.31; 95% CI 2.53, 11.12). Narrative synthesis indicated that quality improvement interventions led to significant improvements in time from discharge to scheduled appointment (1/1 studies), attendance (3/4), prescription of guideline-directed medical therapy (1/1), and completion (1/1). Few studies reported patient outcomes.

conclusionQuality improvement interventions improve referral to CR by up to eight times. While caution is warranted, quality improvement interventions may also lower wait times and increase programme utilization. Future studies are needed. REGISTRATION PROSPERO: CRD42024557586. LAY SUMMARY:

Indexed as

Cardiac RehabilitationQuality ImprovementHumansCardiac rehabilitationCardiovascular diseasesHealth careMeta-analysisOutcome and process assessmentQuality improvementSystematic review

Identifiers

PMID40674512

DOI10.1093/ehjqcco/qcaf067

PMCPMC12714378

What OpenQuestion holds

Textmetadata

LicenceCC BY-NC

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.