Gijs van Halewijn1, Jaap Deckers2, Hung Yong Tay3, Ron van Domburg4, Kornelia Kotseva3, David Wood3. 1. Department of Cardiology, Thoraxcentre Erasmus Medical Centre, Rotterdam, The Netherlands; International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK. 2. Department of Cardiology, Thoraxcentre Erasmus Medical Centre, Rotterdam, The Netherlands. 3. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK. 4. Department of Cardiology, Thoraxcentre Erasmus Medical Centre, Rotterdam, The Netherlands. Electronic address: r.vandomburg@erasmusmc.nl.
Abstract
BACKGROUND: Meta-analyses of cardiac rehabilitation trials up to 2010 showed a significant reduction in all-cause mortality but many of these trials were conducted before the modern management of acute coronary syndromes. METHODS: We undertook a meta-analysis of contemporary randomised controlled trials published in the period 2010 to 2015, including patients with other forms of atherosclerotic cardiovascular disease, to investigate the impact of cardiovascular prevention and rehabilitation on hard outcomes including survival. RESULTS: 18 trials randomising 7691 patients to cardiovascular prevention and rehabilitation or usual care were selected. All-cause mortality was not reduced (RR 1.00, 95% CI 0.88 to 1.14), but cardiovascular mortality was by 58% (95% CI 0.21, 0.88). Myocardial infarction was also reduced by 30% (95% CI 0.54, 0.91) and cerebrovascular events by 60% (95% CI 0.22, 0.74). Comprehensive programmes managing six or more risk factors reduced all-cause mortality in a subgroup analysis (RR 0.63, 95% CI 0.43, 0.93) but those managing less did not. In the three programmes that prescribed and monitored cardioprotective medications for blood pressure and lipids all-cause mortality was also reduced (RR 0.35, 95% CI 0.18, 0.70). CONCLUSIONS: Comprehensive prevention and rehabilitation programmes managing six or more risk factors, and those prescribing and monitoring medications within programmes to lower blood pressure and lipids, continue to reduce all-cause mortality. In addition, these comprehensive programmes not only reduced cardiovascular mortality and myocardial infarction but also, for the first time, cerebrovascular events, and all these outcomes across a broader spectrum of patients with atherosclerotic disease. Copyright Â
BACKGROUND: Meta-analyses of cardiac rehabilitation trials up to 2010 showed a significant reduction in all-cause mortality but many of these trials were conducted before the modern management of acute coronary syndromes. METHODS: We undertook a meta-analysis of contemporary randomised controlled trials published in the period 2010 to 2015, including patients with other forms of atherosclerotic cardiovascular disease, to investigate the impact of cardiovascular prevention and rehabilitation on hard outcomes including survival. RESULTS: 18 trials randomising 7691 patients to cardiovascular prevention and rehabilitation or usual care were selected. All-cause mortality was not reduced (RR 1.00, 95% CI 0.88 to 1.14), but cardiovascular mortality was by 58% (95% CI 0.21, 0.88). Myocardial infarction was also reduced by 30% (95% CI 0.54, 0.91) and cerebrovascular events by 60% (95% CI 0.22, 0.74). Comprehensive programmes managing six or more risk factors reduced all-cause mortality in a subgroup analysis (RR 0.63, 95% CI 0.43, 0.93) but those managing less did not. In the three programmes that prescribed and monitored cardioprotective medications for blood pressure and lipids all-cause mortality was also reduced (RR 0.35, 95% CI 0.18, 0.70). CONCLUSIONS: Comprehensive prevention and rehabilitation programmes managing six or more risk factors, and those prescribing and monitoring medications within programmes to lower blood pressure and lipids, continue to reduce all-cause mortality. In addition, these comprehensive programmes not only reduced cardiovascular mortality and myocardial infarction but also, for the first time, cerebrovascular events, and all these outcomes across a broader spectrum of patients with atherosclerotic disease. Copyright Â
Authors: Raquel Rodrigues Britto; Marta Supervia; Karam Turk-Adawi; Gabriela Suéllen da Silva Chaves; Ella Pesah; Francisco Lopez-Jimenez; Danielle Aparecida Gomes Pereira; Artur H Herdy; Sherry L Grace Journal: Braz J Phys Ther Date: 2019-03-05 Impact factor: 3.377
Authors: Dirk De Bacquer; Delphine De Smedt; Kornelia Kotseva; Catriona Jennings; David Wood; Lars Rydén; Viveca Gyberg; Bahira Shahim; Philippe Amouyel; Jan Bruthans; Almudena Castro Conde; Renata Cífková; Jaap W Deckers; Johan De Sutter; Mirza Dilic; Maryna Dolzhenko; Andrejs Erglis; Zlatko Fras; Dan Gaita; Nina Gotcheva; John Goudevenos; Peter Heuschmann; Aleksandras Laucevicius; Seppo Lehto; Dragan Lovic; Davor Miličić; David Moore; Evagoras Nicolaides; Raphael Oganov; Andrzej Pajak; Nana Pogosova; Zeljko Reiner; Martin Stagmo; Stefan Störk; Lale Tokgözoğlu; Dusko Vulic; Martin Wagner; Guy De Backer Journal: Eur J Epidemiol Date: 2018-10-23 Impact factor: 8.082