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Exercise-based cardiac rehabilitation for adults with heart failure - 2023 Cochrane systematic review and meta-analysis
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Molloy, Cal D., Long, Linda, Mordi, Ify, Bridges, Charlene, Sagar, Viral, Davies, Edward, Coats, Andrew J. S., Dalal, Hasnain, Rees, Karen, Singh, Sally and Taylor, Rod S. (2023) Exercise-based cardiac rehabilitation for adults with heart failure - 2023 Cochrane systematic review and meta-analysis. European Journal of Heart Failure, 25 (12). pp. 2263-2273. doi:10.1002/ejhf.3046 ISSN 1388-9842.
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Official URL: https://doi.org/10.1002/ejhf.3046
Abstract
Aims
Despite strong evidence, access to exercise-based cardiac rehabilitation (ExCR) remains low across global healthcare systems. We provide a contemporary update of the Cochrane review randomized trial evidence for ExCR for adults with heart failure (HF) and compare different delivery modes: centre-based, home-based (including digital support), and both (hybrid).
Methods and results
Databases, bibliographies of previous systematic reviews and included trials, and trials registers were searched with no language restrictions. Randomized controlled trials, recruiting adults with HF, assigned to either ExCR or a no-exercise control group, with follow-up of ≥6 months were included. Two review authors independently screened titles for inclusion, extracted trial and patient characteristics, outcome data, and assessed risk of bias. Outcomes of mortality, hospitalization, and health-related quality of life (HRQoL) were pooled across trials using meta-analysis at short-term (≤12 months) and long-term follow-up (>12 months) and stratified by delivery mode. Sixty trials (8728 participants) were included. In the short term, compared to control, ExCR did not impact all-cause mortality (relative risk [RR] 0.93; 95% confidence interval [CI] 0.71–1.21), reduced all-cause hospitalization (RR 0.69; 95% CI 0.56–0.86, number needed to treat: 13, 95% CI 9–22), and was associated with a clinically important improvement in HRQoL measured by the Minnesota Living with Heart Failure Questionnaire (MLWHF) overall score (mean difference: −7.39; 95% CI −10.30 to −4.47). Improvements in outcomes with ExCR was seen across centre, home (including digitally supported), and hybrid settings. A similar pattern of results was seen in the long term (mortality: RR 0.87, 95% CI 0.72–1.04; all-cause hospitalization: RR 0.84, 95% CI 0.70–1.01, MLWHF: −9.59, 95% CI −17.48 to −1.50).
Conclusions
To improve global suboptimal levels of uptake for HF patients, global healthcare systems need to routinely recommend ExCR and offer a choice of mode of delivery, dependent on an individual patient's level of risk and complexity.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Library of Congress Subject Headings (LCSH): | Heart failure , Heart -- Diseases -- Patients -- Rehabilitation, Cardiovascular system -- Diseases -- Exercise therapy | ||||||||
Journal or Publication Title: | European Journal of Heart Failure | ||||||||
Publisher: | John Wiley & Sons Ltd. | ||||||||
ISSN: | 1388-9842 | ||||||||
Official Date: | December 2023 | ||||||||
Dates: |
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Volume: | 25 | ||||||||
Number: | 12 | ||||||||
Page Range: | pp. 2263-2273 | ||||||||
DOI: | 10.1002/ejhf.3046 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Re-use Statement: | This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Copyright Holders: | © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. | ||||||||
Date of first compliant deposit: | 19 September 2023 | ||||||||
Date of first compliant Open Access: | 1 November 2023 | ||||||||
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