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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Effects of exercise based cardiac rehabilitation delivery modes on chronic heart failure: a systematic review and
Chen Hua1, Wenrui Huang2, Zhen Chen3
1The Second Affiliated Hospital of Army Medical University: Xinqiao Hospital, Chongqing, 400037, China.
Insights
Combined cardiac rehabilitation with aerobic and resistance training (HCR [AE+RE]) is most effective for improving quality of life and exercise capacity in chronic heart failure patients. Other methods show benefits for specific cardiac metrics.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Evidence-Based Practice
Background:
- Chronic heart failure (CHF) is a severe cardiovascular condition requiring effective management.
- Cardiac rehabilitation (CR) is crucial for CHF, but optimal delivery modes require clarification.
- Existing studies show inconsistent efficacy of CR interventions across diverse patient and healthcare settings.
Purpose of the Study:
- To conduct a comprehensive network meta-analysis comparing the efficacy of various cardiac rehabilitation interventions for chronic heart failure.
- To identify the most effective CR delivery modes for improving patient outcomes, including quality of life, exercise capacity, and clinical markers.
Main Methods:
- Systematic literature searches across major databases (PubMed, Embase, etc.) up to August 2024.
- Independent screening, data extraction, and quality assessment of 33 studies involving 11 interventions.
- Pairwise and network meta-analyses using Stata 17.0 to compare interventions against routine care.
Main Results:
- All evaluated CR interventions surpassed routine care.
- Combined CR (aerobic exercise + resistance training) [HCR (AE+RE)] significantly improved quality of life (MLHFQ) and exercise capacity (6MWT), reducing rehospitalization.
- Center-based CR with high-intensity interval training [CBCR (HIIT)] optimized left ventricular ejection fraction (LVEF); CBCR with aerobic exercise [CBCR (AE)] maximized peak oxygen uptake (Peak VO2).
Conclusions:
- HCR (AE+RE) is the leading intervention for enhancing quality of life, exercise capacity, and reducing hospital readmissions in CHF.
- CBCR (HIIT) is optimal for improving cardiac function (LVEF), while CBCR (AE) excels in boosting cardiorespiratory fitness (Peak VO2).
- This analysis provides evidence-based guidance for tailoring CR interventions to specific patient needs and goals in CHF management.
Abstract:
Chronic heart failure (CHF) represents one of the most severe and advanced stages of cardiovascular disease. Despite the critical importance of cardiac rehabilitation (CR) in CHF management, while studies have explored the effectiveness of various CR delivery modes and offered valuable context-specific insights, their relative efficacy remains inconsistent across different patient groups, healthcare environments, and intervention approaches. A clearer understanding requires comprehensive comparisons and in-depth analyses to address these variations. Systematic searches were conducted in databases including Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, up to August 2024. Two researchers independently screened the literature according to strict inclusion criteria, extracted relevant data, and assessed the quality of included studies using Cochrane Collaboration tools and the Jadad scale. Subsequent pairwise and network meta-analyses were performed using statistical software, including Stata 17.0, to present the results graphically. The network meta-analysis included 9,552 articles, with 33 meeting the inclusion criteria and examining eleven different interventions. All interventions outperformed routine care. Combined CR with aerobic exercise and resistance training (HCR [AE + RE]) significantly improved Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores and 6-min walk test (6MWT) performance, and reduced rehospitalization rates [SUCRA = 96%]. Center-based cardiac rehabilitation (CBCR) with high-intensity interval training (HIIT) was the most effective in enhancing left ventricular ejection fraction (LVEF), while CBCR(AE) demonstrated the greatest improvement in peak oxygen uptake (Peak VO2) [RR = 3.64, 95% CI: 1.66-7.95]. Our analysis identifies HCR (AE + RE) as the most effective intervention for improving quality of life (MLHFQ), exercise capacity (6MWT), and reducing hospital readmissions. CBCR (HIIT) was optimal for enhancing cardiac function through improved LVEF, while CBCR (AE) effectively boosted peak VO2.PROSPERO: CRD42024517039, Review Completed not published.
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