Rod S Taylor1, Sarah Walker2, Neil A Smart3, Massimo F Piepoli4, Fiona C Warren5, Oriana Ciani6, David Whellan7, Christopher O'Connor8, Steven J Keteyian9, Andrew Coats10, Constantinos H Davos11, Hasnain M Dalal12, Kathleen Dracup13, Lorraine S Evangelista14, Kate Jolly15, Jonathan Myers16, Birgitta B Nilsson17, Claudio Passino18, Miles D Witham19, Gloria Y Yeh20. 1. Institute of Health Research, College of Medicine and Health, University of Exeter and Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom. Electronic address: r.taylor@exeter.ac.uk. 2. Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom. Electronic address: https://twitter.com/Sarah1003Walker. 3. University of New England, Armidale, New South Wales, Australia. 4. Cardiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. 5. Exeter Collaboration for Academic Primary Care, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom. 6. Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom; Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy. 7. Department of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania. 8. Duke Clinical Research Institute, Durham, North Carolina. 9. Department of Medicine, Henry Ford Hospital, Detroit, Michigan. 10. IRCCS, San Raffaele, Pisana, Italy. 11. Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece. 12. Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom; Research, Development & Innovation, Royal Cornwall Hospital, Truro, United Kingdom. 13. School of Nursing, University of California San Francisco, San Francisco, California. 14. University of California Irvine, Irvine, California. 15. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom. 16. VA Palo Alto Health Care System/Stanford University, Stanford, California. 17. Division of Medicine, Oslo University Hospital and Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway. 18. Fondazione G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy. 19. NIHR Newcastle Biomedical Research Centre, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom. 20. Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts.
Abstract
BACKGROUND: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups. OBJECTIVES: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. METHODS: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics. RESULTS: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups. CONCLUSIONS: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170).
BACKGROUND: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups. OBJECTIVES: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. METHODS: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics. RESULTS: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups. CONCLUSIONS: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170).
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