Home-Based Cardiac Rehabilitation in Cardiovascular Diseases: A Narrative Review of Progress, Challenges, and Future Directions.

Background: Cardiac rehabilitation (CR) is an evidence-based secondary prevention strategy for patients with cardiovascular disease, yet participation in conventional center-based programs remains low. Home-based cardiac rehabilitation (HBCR) has emerged as an alternative delivery model intended to reduce access barriers while preserving the core components of CR. Methods: This narrative review synthesizes contemporary evidence and implementation literature on HBCR, with emphasis on clinical effectiveness, digital and hybrid delivery models, equity, and health-system implementation. Results: Current evidence indicates that HBCR can achieve outcomes comparable to center-based CR in selected clinically stable, low- to moderate-risk patients, including similar effects on mortality, morbidity, exercise capacity, and cardiovascular risk-factor modification. Digital health tools and hybrid models may improve reach, adherence, monitoring, and personalization. However, implementation remains uneven, reimbursement pathways are inconsistent, and many studies have limited representation of women, racial and ethnic minority groups, older adults, socioeconomically disadvantaged populations, and patients with complex comorbidities. Conclusion: HBCR should be viewed as a complementary model within comprehensive CR rather than a universal replacement for center-based services. Future work should prioritize transparent implementation frameworks, equitable digital access, long-term outcomes, cost-effectiveness, and identification of patients best served by home-based, center-based, or hybrid CR models.