Exercise-based cardiac rehabilitation for adults with heart failure

Area of Science:

• Cardiology and Exercise Science
• Heart Failure Management
• Rehabilitation Medicine

Background:

• Heart failure (HF) presents a significant burden, impacting exercise tolerance, quality of life (QoL), and increasing mortality and hospitalization risks.
• Previous reviews indicated exercise-based cardiac rehabilitation (ExCR) improves QoL and reduces hospital admissions in HF patients, with potential long-term mortality benefits.
• Limitations of prior research included underrepresentation of women, older individuals, and patients with heart failure with preserved ejection fraction (HFpEF), and a focus on center-based programs.

Purpose of the Study:

• To evaluate the impact of exercise-based cardiac rehabilitation (ExCR) on mortality, hospital admissions, and health-related quality of life (HRQoL) in adults with heart failure (HF).
• To synthesize evidence from randomized controlled trials (RCTs) comparing ExCR with no-exercise controls.
• To assess the consistency of ExCR effects across different patient groups and delivery settings.

Main Methods:

• A comprehensive search of multiple electronic databases (CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Web of Science) was conducted up to December 2021.
• Included were 60 RCTs (8728 participants) with a minimum six-month follow-up, comparing ExCR interventions against no-exercise controls in adults with heart failure (HFrEF or HFpEF).
• Primary outcomes included all-cause mortality, HF-specific mortality, all-cause hospital admissions, HF-related hospital admissions, and HRQoL, analyzed using standard Cochrane methods and GRADE for evidence certainty.

Main Results:

• No significant difference in all-cause mortality was observed between ExCR and usual care in the short term (low-certainty evidence).
• ExCR participation likely reduced the risk of all-cause hospital admissions (moderate-certainty evidence) and heart failure-related hospital admissions (moderate-certainty evidence).
• ExCR likely improved short-term HRQoL, with consistent benefits observed across various delivery models, including home-based and comprehensive programs (moderate to very-low certainty evidence).

Conclusions:

• This updated review confirms that ExCR is associated with reduced hospital admissions and improved HRQoL in heart failure patients, with no clear impact on short-term mortality.
• Evidence supports the efficacy of diverse ExCR delivery methods, including home-based and digitally supported programs, expanding accessibility.
• Future research should prioritize recruiting underrepresented groups, such as older adults, women, and individuals with HFpEF, to ensure broader applicability of ExCR benefits.