Effectiveness of Nurse-Led Cardiac Rehabilitation Compared to Routine Care: A Systematic Review.

Nurse-led cardiac rehabilitation (CR) models place nurses at the centre of exercise training, risk factor modification and education. By leveraging nursing expertise and structured pathways, these services are designed to improve accessibility, adherence, and continuity while preserving safety and clinical standards. Despite increasing adoption, their impact compared to routine care remains uncertain. We therefore conducted a systematic review which evaluated the effectiveness of nurse-led CR compared with routine care for adults with cardiovascular disease. This review was conducted and reported in accordance with PRISMA guidelines. The protocol was prospectively registered on PROSPERO (CRD420251039182). Comprehensive searches were performed across MEDLINE (PubMed and Ovid), Embase, Cochrane CENTRAL, CINAHL, and Scopus for studies published between January 2000 and June 2025. Randomised controlled trials (RCTs) comparing nurse-led CR, defined as programmes primarily delivered, coordinated, or supervised by nurses with routine or usual care, were included. Eligible participants were adults (≥18 years) with established cardiovascular disease. Studies led exclusively by non-nursing professionals or involving paediatric populations were excluded. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Certainty of evidence was appraised using the GRADE framework. Of 1,997 identified records, six RCTs (n=922) met the inclusion criteria, conducted across India, China, and the UK. Populations encompassed stable cardiac cohorts, including heart failure and post-PCI patients. Interventions ranged from centre-based to hybrid and virtual formats. Nurse-led CR consistently produced significant, clinically meaningful improvements in quality of life (QoL) (moderate-certainty evidence), observed across both generic (SF-36, EuroQol) and disease-specific (MLHFQ, SAQ, MacNew) instruments, with benefits sustained up to seven months. Functional capacity also improved significantly (moderate-certainty evidence), reflected by increases in walking distance (e.g., +44.9 m on the 6-minute walk test), strength, and mobility. Patient-reported outcomes such as angina frequency and perceived exertion similarly favoured the intervention. Four studies demonstrated reductions in hospital readmissions (absolute risk reduction 8-10%) and fewer total hospital days (low-certainty evidence). Mortality was rarely reported, with no significant difference between groups over short-term follow-up (very low-certainty evidence). Nurse-led cardiac rehabilitation is an effective and safe model of care that significantly enhances quality of life and functional capacity in adults with cardiovascular disease. Evidence suggests potential benefits in reducing hospital utilisation, warranting confirmation in larger, longer-term trials. The flexibility of nurse-led CR across diverse settings supports its scalability and integration into existing services, particularly in systems constrained by workforce shortages or serving underserved populations. Broader implementation could strengthen secondary prevention efforts and improve key patient-centred outcomes. Future research should incorporate standardised outcome measures and formal economic evaluations to guide policy and resource allocation.