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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiac rehabilitation for patients having cardiac surgery: a systematic review
Fredrike Blokzijl1, Willem Dieperink2, Frederik Keus2
1Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands - f.zwiers-blokzijl@umcg.nl.
Insights
Cardiac rehabilitation (CR) after cardiac surgery shows no significant mortality benefit in randomized trials. Observational studies suggest benefits, but more high-quality research is needed for reliable conclusions on CR effectiveness.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Evidence-Based Medicine
Background:
- Cardiac rehabilitation (CR) is recommended for cardiac patients.
- The effectiveness of CR specifically after cardiac surgery remains unclear.
- This study systematically reviews CR's impact on post-cardiac surgery patients.
Purpose of the Study:
- To systematically review the effects of cardiac rehabilitation (CR) in patients following cardiac surgery.
- To compare CR outcomes against standard treatment.
- To assess CR's impact on mortality, adverse events, quality of life, and other relevant outcomes.
Main Methods:
- Systematic review of randomized clinical trials (RCTs), quasi-randomized, and observational studies.
- Searched Cochrane Library, PubMed/MEDLINE, and EMBASE up to October 2017.
- Assessed risk of bias and quality of evidence using GRADE criteria.
Main Results:
- Included 18 RCTs and 15 observational studies; only one observational study had low risk of bias.
- Meta-analysis of RCTs found no significant difference in all-cause mortality (RR 0.93).
- Observational studies indicated a significant benefit of CR on mortality (RR 0.49), but CR did not significantly impact other outcomes.
Conclusions:
- Current evidence is insufficient to reliably conclude on the effectiveness of CR after cardiac surgery.
- Future research requires low risk of bias and clearly defined outcomes.
- Further high-quality trials are necessary to establish CR's role in post-cardiac surgery care.
Introduction:
Cardiac rehabilitation (CR) is recommended for all cardiac patients including patients after cardiac surgery. Since the effect of CR after cardiac surgery has not been well established yet, we conducted a systematic review on the effects of CR for patients after cardiac surgery compared to treatment as usual.
Evidence Acquisition:
A systematic review of randomized clinical trials (RCTs), quasi-randomized and prospective observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE was undertaken until October 18th, 2017. Adults after any kind of cardiac surgery were included. Primary outcome was all-cause mortality, other outcomes were serious adverse events, health-related quality of life, work participation, functioning and costs/cost-effectiveness. Risk of bias was evaluated, and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.
Evidence Synthesis:
Eighteen RCTs and 15 observational studies were included. Low risk of bias was only observed in one observational study. Meta-analysis of RCTs suggested no significant difference of CR compared to control on mortality (random-effects relative risk (RR) 0.93 (95% CI: 0.40-1.81), while observational studies suggested statistically significant beneficial effect associated with CR (random-effects RR=0.49, 95% CI: 0.35 - 0.68). CR did not significantly affect any of the other outcomes. Due to the limited data TSA could not be performed.
Conclusions:
The body of evidence does not allow us to reach any reliable conclusions about the effectiveness of CR following cardiac surgery. Future trials need to be conducted with low risks of bias and clearly defined outcomes.
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