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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis
Lindsey Anderson1, Neil Oldridge2, David R Thompson3
1Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
Insights
Exercise-based cardiac rehabilitation (CR) significantly reduces cardiovascular mortality and hospital admissions for coronary heart disease (CHD) patients. This updated meta-analysis confirms CR
Area of Science:
- Cardiology
- Public Health
- Exercise Science
Background:
- Existing meta-analyses on exercise-based cardiac rehabilitation (CR) for coronary heart disease (CHD) have raised applicability concerns.
- Guidelines recommend CR, but evidence requires updated synthesis.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis of exercise-based CR for CHD.
- To evaluate the effectiveness of CR interventions on mortality, morbidity, and quality of life.
Main Methods:
- Searched multiple databases (e.g., MEDLINE, EMBASE) up to July 2014.
- Included randomized controlled trials (RCTs) with ≥6 months follow-up comparing CR to no-exercise controls.
- Utilized random-effects meta-analysis and stratified analyses to assess effect modifiers.
Main Results:
- Included 63 studies with 14,486 participants; median follow-up was 12 months.
- CR significantly reduced cardiovascular mortality (RR 0.74) and hospital admissions (RR 0.82).
- No significant effects on total mortality, myocardial infarction, or revascularization; improved quality of life observed.
Conclusions:
- Exercise-based CR is confirmed to reduce cardiovascular mortality in CHD patients.
- CR also leads to significant reductions in hospital admissions and improvements in quality of life.
- Benefits are consistent across diverse patient groups, intervention types, and study characteristics.
Background:
Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR).
Objectives:
The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD.
Methods:
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers.
Results:
A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects.
Conclusions:
This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.
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