Rod S Taylor1, Linda Long2, Ify R Mordi3, Michael Tvilling Madsen4, Edward J Davies5, Hasnain Dalal6, Karen Rees7, Sally J Singh8, Christian Gluud9, Ann-Dorthe Zwisler10. 1. Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, United Kingdom. Electronic address: rod.taylor@gla.ac.uk. 2. Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, United Kingdom. 3. Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom. 4. Department of Surgery, Zealand University Hospital, Køge, Denmark, and University of Copenhagen, Koege, Denmark. 5. Cardiothoracic Department, University Hospital Plymouth, Plymouth, United Kingdom. 6. Department of Primary Care, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, United Kingdom; Institute of Health Research, Exeter College of Medicine and Health School, University of Exeter, Exeter, United Kingdom. 7. Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. 8. Department of Respiratory Sciences, University of Leicester College of Life Sciences, National Institute for Health Research, Leicester Biomedical Research Center - Respiratory, Glenfield Hospital, Leicester, United Kingdom. 9. Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 10. REHPA Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern and Odense University Hospital, Copenhagen, Denmark.
Abstract
OBJECTIVES: This study performed a contemporary systematic review and meta-analysis of exercise-based cardiac rehabilitation (ExCR) for heart failure (HF). BACKGROUND: There is an increasing call for trials of models of ExCR for patients with HF that provide alternatives to conventional center-based provision and recruitment of patients that reflect a broader HF population. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched between January 2013 and January 2018. Randomized trials comparing patients undergoing ExCR to control patients not undergoing exercise were included. Study outcomes were pooled using meta-analysis. Metaregression examined potential effect modification according to ExCR program characteristics, and risk of bias, trial sequential analysis (TSA), and Grading of Recommendations Assessment Development and Evaluation (GRADE) were applied. RESULTS: Across 44 trials (n = 5,783; median follow-up of 6 months), compared with control subjects, ExCR did not reduce the risk of all-cause mortality (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.66 to 1.21; TSA-adjusted CI: 0.26 to 3.10) but did reduce all-cause hospitalization (RR: 0.70; 95% CI: 0.60 to 0.83; TSA-adjusted CI: 0.54 to 0.92) and HF-specific hospitalization (RR: 0.59; 95% CI: 0.42 to 0.84; TSA-adjusted CI: 0.14 for 2.46), and patients reported improved Minnesota Living with Heart Failure questionnaire overall scores (mean difference: -7.1; 95% CI: -10.5 to -3.7; TSA-adjusted CI: -13.2 to -1.0). No evidence of differential effects across different models of delivery, including center- versus home-based programs, were found. CONCLUSIONS: This review supports the beneficial effects of ExCR on patient outcomes. These benefits appear to be consistent across ExCR program characteristics. GRADE and TSA assessments indicated that further high-quality randomized trials are needed.
OBJECTIVES: This study performed a contemporary systematic review and meta-analysis of exercise-based cardiac rehabilitation (ExCR) for heart failure (HF). BACKGROUND: There is an increasing call for trials of models of ExCR for patients with HF that provide alternatives to conventional center-based provision and recruitment of patients that reflect a broader HF population. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched between January 2013 and January 2018. Randomized trials comparing patients undergoing ExCR to control patients not undergoing exercise were included. Study outcomes were pooled using meta-analysis. Metaregression examined potential effect modification according to ExCR program characteristics, and risk of bias, trial sequential analysis (TSA), and Grading of Recommendations Assessment Development and Evaluation (GRADE) were applied. RESULTS: Across 44 trials (n = 5,783; median follow-up of 6 months), compared with control subjects, ExCR did not reduce the risk of all-cause mortality (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.66 to 1.21; TSA-adjusted CI: 0.26 to 3.10) but did reduce all-cause hospitalization (RR: 0.70; 95% CI: 0.60 to 0.83; TSA-adjusted CI: 0.54 to 0.92) and HF-specific hospitalization (RR: 0.59; 95% CI: 0.42 to 0.84; TSA-adjusted CI: 0.14 for 2.46), and patients reported improved Minnesota Living with Heart Failure questionnaire overall scores (mean difference: -7.1; 95% CI: -10.5 to -3.7; TSA-adjusted CI: -13.2 to -1.0). No evidence of differential effects across different models of delivery, including center- versus home-based programs, were found. CONCLUSIONS: This review supports the beneficial effects of ExCR on patient outcomes. These benefits appear to be consistent across ExCR program characteristics. GRADE and TSA assessments indicated that further high-quality randomized trials are needed.
Authors: Eduardo Thadeu de Oliveira Correia; Jeffrey I Mechanick; Letícia Mara Dos Santos Barbetta; Antonio José Lagoeiro Jorge; Evandro Tinoco Mesquita Journal: Heart Fail Rev Date: 2022-04-04 Impact factor: 4.214
Authors: Monica Parry; Harriette G C Van Spall; Kerri-Anne Mullen; Sharon L Mulvagh; Christine Pacheco; Tracey J F Colella; Marie-Annick Clavel; Shahin Jaffer; Heather J A Foulds; Jasmine Grewal; Marsha Hardy; Jennifer A D Price; Anna L E Levinsson; Christine A Gonsalves; Colleen M Norris Journal: CJC Open Date: 2022-04-19
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-02
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2020-11-02 Impact factor: 24.094