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Exercise-Based Rehabilitation for Heart Failure: Cochrane Systematic Review, Meta-Analysis, and Trial Sequential

Rod S Taylor1, Linda Long2, Ify R Mordi3

  • 1Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, United Kingdom.

JACC. Heart Failure
|July 15, 2019
PubMed

Insights

Exercise-based cardiac rehabilitation (ExCR) for heart failure (HF) reduces hospitalizations and improves quality of life. While not reducing mortality, ExCR benefits are consistent across various program types, though more research is needed.

Area of Science:

  • Cardiology
  • Rehabilitation Medicine
  • Public Health

Background:

  • Growing demand for alternative exercise-based cardiac rehabilitation (ExCR) models for heart failure (HF) patients.
  • Need for ExCR programs that recruit a broader HF population beyond traditional center-based settings.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis of exercise-based cardiac rehabilitation (ExCR) for heart failure (HF).
  • To evaluate the effectiveness of ExCR on patient outcomes, including mortality, hospitalization, and quality of life.

Main Methods:

  • Systematic review and meta-analysis of 44 randomized trials (n=5,783) published between January 2013 and January 2018.
  • Inclusion of trials comparing ExCR to control groups; outcomes pooled using meta-analysis.
  • Application of metaregression, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation (GRADE) for robust assessment.

Main Results:

  • ExCR did not significantly reduce all-cause mortality (RR: 0.89; 95% CI: 0.66 to 1.21).
  • ExCR significantly reduced all-cause hospitalization (RR: 0.70; 95% CI: 0.60 to 0.83) and HF-specific hospitalization (RR: 0.59; 95% CI: 0.42 to 0.84).
  • Patients reported improved quality of life scores on the Minnesota Living with Heart Failure questionnaire (MD: -7.1; 95% CI: -10.5 to -3.7).

Conclusions:

  • Exercise-based cardiac rehabilitation (ExCR) demonstrates beneficial effects on patient outcomes for heart failure (HF).
  • Benefits of ExCR are consistent across different program characteristics and delivery models.
  • Further high-quality randomized trials are recommended based on GRADE and TSA assessments.
Abstract

Keywords:
exercise trainingheart failuremeta-analysisrandomized controlled trialsrehabilitationtrial sequential analysis

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