The Effectiveness of Nursing-Led Educational Cardiac Rehabilitation Programs on Medication Adherence, Lifestyle Modification, Quality of Life, and Hospital Readmission Rates among Cardiac Patients: A Systematic Review

Abstract

Background: Cardiovascular disease (CVD) remains a major cause of mortality and healthcare burden worldwide and represents an important public health concern in Saudi Arabia. Although advances in acute cardiac care have improved survival, many patients continue to experience difficulties in maintaining medication adherence and recommended lifestyle changes after hospital discharge. Nurse-led cardiac rehabilitation (CR) programs provide structured education, behavioural support, follow-up, and care coordination that may facilitate secondary prevention and improve patient-centred outcomes.

Purpose: This systematic review aimed to synthesise recent evidence regarding the effectiveness of nursing-led educational cardiac rehabilitation programs in improving medication adherence, lifestyle modification, health-related quality of life (QoL), and hospital readmission rates among adult cardiac patients, with particular consideration of the implications for the Saudi healthcare context.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) framework. Electronic searches were conducted in PubMed, CINAHL, and EBSCO for studies published between January 2020 and April 2025. Eligible studies included randomised controlled trials, quasi-experimental studies, cohort studies, qualitative studies, and mixed-methods research involving adults with cardiac conditions and evaluating nurse-led educational or rehabilitation interventions. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Due to heterogeneity in study designs, interventions, outcome measures, and follow-up periods, findings were synthesised narratively.

Results: The review included 20 studies representing a range of nurse-led cardiac rehabilitation models, including hospital-based, home-based, community-based, telehealth, eHealth, and culturally adapted interventions. Eight studies addressed medication adherence, six examined lifestyle modification, ten evaluated health-related quality of life, and five reported hospital readmission outcomes. Overall, the evidence indicated favourable effects of nurse-led cardiac rehabilitation on medication adherence, lifestyle behaviours, and quality of life, while several studies also suggested potential reductions in hospital readmissions.

Conclusion: Nurse-led educational cardiac rehabilitation appears to be a promising patient-centred approach for supporting secondary prevention among cardiac patients. The reviewed evidence highlights the potential contribution of personalised education, continuous follow-up, behavioural support, digital technologies, and cultural adaptation to improved patient outcomes. However, differences in study design, intervention characteristics, outcome measurement, and follow-up duration limit direct comparison across studies. Further high-quality research, particularly in Saudi Arabia and other underrepresented settings, is needed to evaluate the long-term effectiveness, cost-effectiveness, and implementation of culturally appropriate nurse-led cardiac rehabilitation models.