Telehealth-Based Cardiac Rehabilitation for Heart Failure: A Systematic Review of Effectiveness, Access, and Patient-Centred Outcome

<i>Background and Objectives</i>: Heart failure (HF) affects millions globally, with traditional cardiac rehabilitation (CR) improving outcomes but facing access barriers. Telehealth-based CR offers a promising alternative, yet its effectiveness and patient-centred outcomes require updated evaluation. This systematic review aimed to assess the effectiveness, accessibility, and patient-centred outcomes of telehealth-based CR compared with usual care or centre-based CR in adults with HF. <i>Materials and Methods</i>: This systematic review followed PRISMA 2020 guidelines. Eligible studies were randomized controlled trials involving adults with HF receiving telehealth CR (e.g., telephone, apps, remote monitoring) compared with usual care or centre-based CR; non-RCTs and studies lacking relevant outcomes were excluded. Searches of PubMed, Medline, CINAHL, EMBASE, and Web of Science identified studies published between 2020-2025. Primary outcomes were exercise capacity (six-minute walk distance [6MWD], peak VO₂) and quality of life (QoL); secondary outcomes included adherence, satisfaction, and clinical events. Meta-analyses used standardized mean differences (SMD) for 6MWD and QoL. Risk of bias was assessed using PEDro, Jadad, and RoB2 tools. <i>Results</i>: Fourteen randomized controlled trials (total <i>n</i> = 7371 participants) met the inclusion criteria. Telehealth CR significantly improved 6MWD (SMD 0.35, 95% CI 0.15-0.55, <i>p</i> < 0.001; 6 studies) and QoL (SMD 0.28, 95% CI 0.10-0.46, <i>p</i> = 0.002; 8 studies) compared to usual care, showing equivalence to center-based CR. Adherence ranged from 70-92% and satisfaction 75-96%, and hospitalizations declined in some studies, though mortality benefits were not observed. <i>Conclusions</i>: Telehealth CR is effective, accessible, and patient-centred for individuals with HF, performing comparably to centre-based CR and better than usual care. It should be integrated into standard HF management, supported by policy and technology investment. Evidence is limited by short follow-up durations and moderate heterogeneity among trials.