Fredrike Blokzijl1, Willem Dieperink2, Frederik Keus2, Michiel F Reneman3, Massimo A Mariani4, Iwan C van der Horst2. 1. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands - f.zwiers-blokzijl@umcg.nl. 2. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 3. Department of Rehabilitation Medicine University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 4. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Abstract
INTRODUCTION: Cardiac rehabilitation (CR) is recommended for all cardiac patients including patients after cardiac surgery. Since the effect of CR after cardiac surgery has not been well established yet, we conducted a systematic review on the effects of CR for patients after cardiac surgery compared to treatment as usual. EVIDENCE ACQUISITION: A systematic review of randomized clinical trials (RCTs), quasi-randomized and prospective observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE was undertaken until October 18th, 2017. Adults after any kind of cardiac surgery were included. Primary outcome was all-cause mortality, other outcomes were serious adverse events, health-related quality of life, work participation, functioning and costs/cost-effectiveness. Risk of bias was evaluated, and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. EVIDENCE SYNTHESIS: Eighteen RCTs and 15 observational studies were included. Low risk of bias was only observed in one observational study. Meta-analysis of RCTs suggested no significant difference of CR compared to control on mortality (random-effects relative risk (RR) 0.93 (95% CI: 0.40-1.81), while observational studies suggested statistically significant beneficial effect associated with CR (random-effects RR=0.49, 95% CI: 0.35 - 0.68). CR did not significantly affect any of the other outcomes. Due to the limited data TSA could not be performed. CONCLUSIONS: The body of evidence does not allow us to reach any reliable conclusions about the effectiveness of CR following cardiac surgery. Future trials need to be conducted with low risks of bias and clearly defined outcomes.
INTRODUCTION: Cardiac rehabilitation (CR) is recommended for all cardiac patients including patients after cardiac surgery. Since the effect of CR after cardiac surgery has not been well established yet, we conducted a systematic review on the effects of CR for patients after cardiac surgery compared to treatment as usual. EVIDENCE ACQUISITION: A systematic review of randomized clinical trials (RCTs), quasi-randomized and prospective observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE was undertaken until October 18th, 2017. Adults after any kind of cardiac surgery were included. Primary outcome was all-cause mortality, other outcomes were serious adverse events, health-related quality of life, work participation, functioning and costs/cost-effectiveness. Risk of bias was evaluated, and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. EVIDENCE SYNTHESIS: Eighteen RCTs and 15 observational studies were included. Low risk of bias was only observed in one observational study. Meta-analysis of RCTs suggested no significant difference of CR compared to control on mortality (random-effects relative risk (RR) 0.93 (95% CI: 0.40-1.81), while observational studies suggested statistically significant beneficial effect associated with CR (random-effects RR=0.49, 95% CI: 0.35 - 0.68). CR did not significantly affect any of the other outcomes. Due to the limited data TSA could not be performed. CONCLUSIONS: The body of evidence does not allow us to reach any reliable conclusions about the effectiveness of CR following cardiac surgery. Future trials need to be conducted with low risks of bias and clearly defined outcomes.
Authors: Grace Dibben; James Faulkner; Neil Oldridge; Karen Rees; David R Thompson; Ann-Dorthe Zwisler; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2021-11-06
Authors: Johanneke Hartog; Fredrike Blokzijl; Sandra Dijkstra; Mike J L DeJongste; Michiel F Reneman; Willem Dieperink; Iwan C C van der Horst; Joke Fleer; Lucas H V van der Woude; Pim van der Harst; Massimo A Mariani Journal: BMJ Open Date: 2019-09-18 Impact factor: 2.692
Authors: Bernhard Rauch; Annett Salzwedel; Birna Bjarnason-Wehrens; Christian Albus; Karin Meng; Jean-Paul Schmid; Werner Benzer; Matthes Hackbusch; Katrin Jensen; Bernhard Schwaab; Johann Altenberger; Nicola Benjamin; Kurt Bestehorn; Christa Bongarth; Gesine Dörr; Sarah Eichler; Hans-Peter Einwang; Johannes Falk; Johannes Glatz; Stephan Gielen; Maurizio Grilli; Ekkehard Grünig; Manju Guha; Matthias Hermann; Eike Hoberg; Stefan Höfer; Harald Kaemmerer; Karl-Heinz Ladwig; Wolfgang Mayer-Berger; Maria-Inti Metzendorf; Roland Nebel; Rhoia Clara Neidenbach; Josef Niebauer; Uwe Nixdorff; Renate Oberhoffer; Rona Reibis; Nils Reiss; Daniel Saure; Axel Schlitt; Heinz Völler; Roland von Känel; Susanne Weinbrenner; Ronja Westphal Journal: J Clin Med Date: 2021-05-19 Impact factor: 4.241