Effectiveness, Efficacy, and Safety of Home-Based Cardiac Rehabilitation Following Valve Replacement or Repair: Protocol for a Systematic Review.

backgroundCardiac rehabilitation (CR) is recommended following valve replacement or repair procedures (VRPs), yet participation remains suboptimal among patients undergoing VRPs. Home-based CR (HBCR), including both fully digital and hybrid (mix of HBCR and center-based CR [CBCR]) models, may improve access and uptake. Although prior systematic reviews have examined HBCR in general populations receiving CR, none have specifically considered HBCR among patients who have undergone VRPs-an expanding but under-studied group with distinct rehabilitation needs.

objectiveWe aim to perform a systematic review that will evaluate the effectiveness, efficacy, and safety of HBCR compared with CBCR and usual care or no CR in adults following VRPs.

methodsThis systematic review protocol follows guidance from the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) 2015 statement. We will conduct a systematic search in bibliographic databases (MEDLINE, Embase, CENTRAL, CINAHL, and core databases of Web of Science) and ClinicalTrials.gov. Eligible study designs include randomized and nonrandomized controlled trials, controlled observational studies, and single-group cohort or intervention studies. Primary outcomes are major adverse cardiac events, all-cause mortality, and health system resource use. Secondary outcomes are program adherence, quality of life, and patient satisfaction. Two reviewers will independently screen studies for eligibility. One reviewer will perform data extraction using a predefined template, and a second reviewer will independently verify all extracted data for accuracy and completeness. Risk of bias will be assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials, the Risk of Bias in Nonrandomized Studies of Interventions tool, and the National Institutes of Health quality assessment tool for before-and-after (pretest-posttest) studies with no control group. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Where appropriate, findings will be synthesized narratively and through meta-analysis.

resultsThe review formally began in May 2025 and will be conducted and reported according to the protocol; any changes to this protocol will be documented, updated in the PROSPERO registration, and reported alongside the review findings. As of August 2025, the search identified 398 records, of which 156 (39.2%) were assessed for eligibility, and 21 (5.3%) studies met the inclusion criteria and were retained for data extraction. The results of the review are expected to be published in the first quarter of 2027.

conclusionsThe review aims to focus on clinical-, patient-, and system-important outcomes, which, as a secondary objective, will provide input parameters for planned economic modeling. The findings of this systematic review will inform both practice and policy and provide a foundation for health system-level feasibility assessment, economic modeling, and policy planning related to HBCR in this population.

trial registrationPROSPERO CRD420251066703; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251066703. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/86832.