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Exercise-based rehabilitation for heart failure : systematic review and meta-analysis
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Sagar, Viral A., Davies, Ed J., Briscoe, Simon, Coats, Andrew J. S., Dalal, Hasnain M., Lough, Fiona, Rees, Karen, Singh, Sally and Taylor, Rod (Rod S.) (2015) Exercise-based rehabilitation for heart failure : systematic review and meta-analysis. Open Heart, Volume 2 (Number 1). Article number e000163. doi:10.1136/openhrt-2014-000163
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Official URL: http://dx.doi.org/10.1136/openhrt-2014-000163
Abstract
Objective: To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure.
Methods: A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control.
Results: 33 trials were included with 4740 participants predominantly with a reduced ejection fraction (<40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1 year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: −5.8 points, −9.2 to −2.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow- up, quality or publication date.
Conclusions: This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.
| 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 > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Heart failure -- Exercise therapy | ||||||||
| Journal or Publication Title: | Open Heart | ||||||||
| Publisher: | B M J Group | ||||||||
| ISSN: | 2053-3624 | ||||||||
| Official Date: | 28 January 2015 | ||||||||
| Dates: |
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| Volume: | Volume 2 | ||||||||
| Number: | Number 1 | ||||||||
| Article Number: | Article number e000163 | ||||||||
| DOI: | 10.1136/openhrt-2014-000163 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||||
| Grant number: | RP-PG-1210-12004 (NIHR) | ||||||||
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