RT Journal Article
SR Electronic
T1 Exercise-based rehabilitation for heart failure: systematic review and meta-analysis
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000163
DO 10.1136/openhrt-2014-000163
VO 2
IS 1
A1 Viral A Sagar
A1 Edward J Davies
A1 Simon Briscoe
A1 Andrew J S Coats
A1 Hasnain M Dalal
A1 Fiona Lough
A1 Karen Rees
A1 Sally Singh
A1 Rod S Taylor
YR 2015
UL http://openheart.bmj.com/content/2/1/e000163.abstract
AB 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.