Birna Bjarnason-Wehrens1, R Nebel2, K Jensen3, M Hackbusch3, M Grilli4, S Gielen5,6, B Schwaab7, B Rauch8. 1. Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany. 2. Hermann-Albrecht-Klinik Mettnau, Germany. 3. Institute of Medical Biometry and Informatics, University of Heidelberg, Germany. 4. Medical Faculty University Library, University of Mannheim-Heidelberg, Germany. 5. Department of Cardiology, Angiology and Intensive Care, Klinikum Lippe, Detmold, Germany. 6. Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 7. Curschmann Klinik, Timmendorfer Strand, Germany. 8. Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany.
Abstract
BACKGROUND: In heart failure with reduced left ventricular ejection fraction (HFrEF) patients the effects of exercise-based cardiac rehabilitation on top of state-of-the-art pharmacological and device therapy on mortality, hospitalization, exercise capacity and quality-of-life are not well established. DESIGN: The design of this study involved a structured review and meta-analysis. METHODS: Evaluation of randomised controlled trials of exercise-based cardiac rehabilitation in HFrEF-patients with left ventricular ejection fraction ≤40% of any aetiology with a follow-up of ≥6 months published in 1999 or later. RESULTS: Out of 12,229 abstracts, 25 randomised controlled trials including 4481 HFrEF-patients were included in the final evaluation. Heterogeneity in study population, study design and exercise-based cardiac rehabilitation-intervention was evident. No significant difference in the effect of exercise-based cardiac rehabilitation on mortality compared to control-group was found (hazard ratio 0.75, 95% confidence interval 0.39-1.41, four studies; 12-months follow-up: relative risk 1.29, 95% confidence interval 0.66-2.49, eight studies; six-months follow-up: relative risk 0.91, 95% confidence interval 0.26-3.16, seven studies). In addition there was no significant difference between the groups with respect to 'hospitalization-for-any-reason' (12-months follow-up: relative risk 0.79, 95% confidence interval 0.41-1.53, four studies), or 'hospitalization-due-to-heart-failure' (12-months follow-up: relative risk 0.59, 95% confidence interval 0.12-2.91, four studies; six-months follow-up: relative risk 0.84, 95% confidence interval 0.07-9.71, three studies). All studies show improvement of exercise capacity. Participation in exercise-based cardiac rehabilitation significantly improved quality-of-life as evaluated with the Kansas City Cardiomyopathy Questionnaire: (six-months follow-up: mean difference 1.94, 95% confidence interval 0.35-3.56, two studies), but no significant results emerged for quality-of-life measured by the Minnesota Living with Heart Failure Questionnaire (nine-months or more follow-up: mean difference -4.19, 95% confidence interval -10.51-2.12, seven studies; six-months follow-up: mean difference -5.97, 95% confidence interval -16.17-4.23, four studies). CONCLUSION: No association between exercise-based cardiac rehabilitation and mortality or hospitalisation could be observed in HFrEF patients but exercise-based cardiac rehabilitation is likely to improve exercise capacity and quality of life.
BACKGROUND: In heart failure with reduced left ventricular ejection fraction (HFrEF) patients the effects of exercise-based cardiac rehabilitation on top of state-of-the-art pharmacological and device therapy on mortality, hospitalization, exercise capacity and quality-of-life are not well established. DESIGN: The design of this study involved a structured review and meta-analysis. METHODS: Evaluation of randomised controlled trials of exercise-based cardiac rehabilitation in HFrEF-patients with left ventricular ejection fraction ≤40% of any aetiology with a follow-up of ≥6 months published in 1999 or later. RESULTS: Out of 12,229 abstracts, 25 randomised controlled trials including 4481 HFrEF-patients were included in the final evaluation. Heterogeneity in study population, study design and exercise-based cardiac rehabilitation-intervention was evident. No significant difference in the effect of exercise-based cardiac rehabilitation on mortality compared to control-group was found (hazard ratio 0.75, 95% confidence interval 0.39-1.41, four studies; 12-months follow-up: relative risk 1.29, 95% confidence interval 0.66-2.49, eight studies; six-months follow-up: relative risk 0.91, 95% confidence interval 0.26-3.16, seven studies). In addition there was no significant difference between the groups with respect to 'hospitalization-for-any-reason' (12-months follow-up: relative risk 0.79, 95% confidence interval 0.41-1.53, four studies), or 'hospitalization-due-to-heart-failure' (12-months follow-up: relative risk 0.59, 95% confidence interval 0.12-2.91, four studies; six-months follow-up: relative risk 0.84, 95% confidence interval 0.07-9.71, three studies). All studies show improvement of exercise capacity. Participation in exercise-based cardiac rehabilitation significantly improved quality-of-life as evaluated with the Kansas City Cardiomyopathy Questionnaire: (six-months follow-up: mean difference 1.94, 95% confidence interval 0.35-3.56, two studies), but no significant results emerged for quality-of-life measured by the Minnesota Living with Heart Failure Questionnaire (nine-months or more follow-up: mean difference -4.19, 95% confidence interval -10.51-2.12, seven studies; six-months follow-up: mean difference -5.97, 95% confidence interval -16.17-4.23, four studies). CONCLUSION: No association between exercise-based cardiac rehabilitation and mortality or hospitalisation could be observed in HFrEF patients but exercise-based cardiac rehabilitation is likely to improve exercise capacity and quality of life.
Authors: Robert S McKelvie; Koon K Teo; Robin Roberts; Neil McCartney; Dennis Humen; Terence Montague; Katie Hendrican; Salim Yusuf Journal: Am Heart J Date: 2002-07 Impact factor: 4.749
Authors: Christopher M O'Connor; David J Whellan; Kerry L Lee; Steven J Keteyian; Lawton S Cooper; Stephen J Ellis; Eric S Leifer; William E Kraus; Dalane W Kitzman; James A Blumenthal; David S Rendall; Nancy Houston Miller; Jerome L Fleg; Kevin A Schulman; Robert S McKelvie; Faiez Zannad; Ileana L Piña Journal: JAMA Date: 2009-04-08 Impact factor: 56.272
Authors: Lindsey Anderson; David R Thompson; Neil Oldridge; Ann-Dorthe Zwisler; Karen Rees; Nicole Martin; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2016-01-05
Authors: Linda Long; Ify R Mordi; Charlene Bridges; Viral A Sagar; Edward J Davies; Andrew Js Coats; Hasnain Dalal; Karen Rees; Sally J Singh; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2019-01-29
Authors: Seongkum Heo; Terry A Lennie; Debra K Moser; Sandra B Dunbar; Susan J Pressler; JinShil Kim Journal: Geriatr Nurs Date: 2022-01-29 Impact factor: 2.361
Authors: Hélène De Cannière; Christophe J P Smeets; Melanie Schoutteten; Carolina Varon; John F Morales Tellez; Chris Van Hoof; Sabine Van Huffel; Willemijn Groenendaal; Pieter Vandervoort Journal: J Clin Med Date: 2020-09-29 Impact factor: 4.964
Authors: Francesco Giallauria; Gianluigi Cuomo; Alessandro Parlato; Nirav Y Raval; Jürgen Kuschyk; Andrew Js Stewart Coats Journal: ESC Heart Fail Date: 2020-07-23