Rongzhong Huang1, Suetonia C Palmer2, Yu Cao3, Hong Zhang4, Yang Sun5, Wenhua Su4, Liwen Liang4, Sanrong Wang6, Ying Wang6, Yu Xu7, Narayan D Melgiri8, Lihong Jiang3, Giovanni F M Strippoli9, Xingsheng Li10. 1. Department of Gerontology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 2. Department of Medicine, University of Otago - Christchurch, Christchurch, New Zealand. 3. Department of Cardiothoracic Surgery, the First People's Hospital of Yunnan Province, Kunming, Yunnan Province, China. 4. Department of Cardiology, the First People's Hospital of Yunnan Province, Kunming, Yunnan Province, China. 5. Institute of Ultrasound Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 6. Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 7. Statistical Laboratory, Chuang Xu Institute of Lifesciences, Chongqing, China. 8. Impactys Foundation for Biomedical Research, San Diego, California, USA. 9. Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. Electronic address: gfmstrippoli@gmail.com. 10. Department of Gerontology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: xingsheng-li@hotmail.com.
Abstract
BACKGROUND: Cardiac rehabilitation is a medically supervised program after coronary events that involves exercise and dietary modification. We evaluated the comparative benefits and harms of cardiac rehabilitation strategies via a network meta-analysis. METHODS: We followed a pre-specified protocol (PROSPERO: CRD42018094998). We searched Embase, MEDLINE, and Cochrane Central Register of Randomized Trials databases for randomized controlled trials that evaluated cardiac rehabilitation vs a second form of rehabilitation or standard/usual care in adults after myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or angiography. Risk of bias and evidence quality was evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. Pairwise and Bayesian network meta-analyses were performed for 11 clinical outcomes. RESULTS: We included 134 randomized controlled trials involving 62,322 participants. Compared with standard care, exercise-only cardiac rehabilitation reduced the odds of cardiovascular mortality (odds ratio [OR], 0.70; 95% credibility interval [CrI], 0.51-0.96; moderate-quality evidence), major adverse cardiovascular events (OR, 0.57; 95% CrI, 0.40-0.78; low-quality evidence), nonfatal myocardial infarction (OR, 0.71; 95% CrI, 0.54-0.93; moderate-quality evidence), all-cause hospitalization (OR, 0.74; 95% CrI, 0.54-0.98; moderate-quality evidence), and cardiovascular hospitalization (OR, 0.69; 95% CrI, 0.51-0.88; moderate-quality evidence). Exercise-only cardiac rehabilitation was associated with lower cardiovascular hospitalization risk relative to cardiac rehabilitation without exercise (OR, 0.68; 95% CrI, 0.48-0.97; moderate-quality evidence). CONCLUSIONS: Cardiac rehabilitation programs containing exercise might provide broader cardiovascular benefits compared with those without exercise.
BACKGROUND: Cardiac rehabilitation is a medically supervised program after coronary events that involves exercise and dietary modification. We evaluated the comparative benefits and harms of cardiac rehabilitation strategies via a network meta-analysis. METHODS: We followed a pre-specified protocol (PROSPERO: CRD42018094998). We searched Embase, MEDLINE, and Cochrane Central Register of Randomized Trials databases for randomized controlled trials that evaluated cardiac rehabilitation vs a second form of rehabilitation or standard/usual care in adults after myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or angiography. Risk of bias and evidence quality was evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. Pairwise and Bayesian network meta-analyses were performed for 11 clinical outcomes. RESULTS: We included 134 randomized controlled trials involving 62,322 participants. Compared with standard care, exercise-only cardiac rehabilitation reduced the odds of cardiovascular mortality (odds ratio [OR], 0.70; 95% credibility interval [CrI], 0.51-0.96; moderate-quality evidence), major adverse cardiovascular events (OR, 0.57; 95% CrI, 0.40-0.78; low-quality evidence), nonfatal myocardial infarction (OR, 0.71; 95% CrI, 0.54-0.93; moderate-quality evidence), all-cause hospitalization (OR, 0.74; 95% CrI, 0.54-0.98; moderate-quality evidence), and cardiovascular hospitalization (OR, 0.69; 95% CrI, 0.51-0.88; moderate-quality evidence). Exercise-only cardiac rehabilitation was associated with lower cardiovascular hospitalization risk relative to cardiac rehabilitation without exercise (OR, 0.68; 95% CrI, 0.48-0.97; moderate-quality evidence). CONCLUSIONS: Cardiac rehabilitation programs containing exercise might provide broader cardiovascular benefits compared with those without exercise.
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