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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Effects of Cardiac Rehabilitation on Cardiac Function and Cardiovascular Adverse Events in Coronary Heart Disease
Xingrong He1, Jing Wang1, Lingyan Ye2
1School of Medicine, Lishui University, 323000 Lishui, Zhejiang, China.
Insights
Comprehensive cardiac rehabilitation (CCR) significantly improves heart function and reduces cardiovascular events in patients after percutaneous coronary intervention (PCI). This approach enhances left ventricular ejection fraction and exercise capacity while lowering major adverse cardiovascular events.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Evidence-Based Medicine
Background:
- Coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) require effective post-procedural management.
- Cardiac rehabilitation (CR) is a critical component of recovery, but the impact of its core components needs comprehensive evaluation.
Purpose of the Study:
- To assess the influence of five central cardiac rehabilitation (CR) prescriptions on cardiac function and cardiovascular complications.
- To evaluate the effectiveness of comprehensive cardiac rehabilitation (CCR) in patients with coronary heart disease (CHD) following first-time PCI.
Main Methods:
- A systematic review and meta-analysis of 16 randomized controlled trials (RCTs) involving 1808 patients.
- Studies included adult patients with ischemic heart disease undergoing first-time PCI, comparing five core CR prescriptions against routine guidance.
- Outcomes assessed included left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), six-minute walk distance (6MWD), and Major Adverse Cardiovascular Events (MACE).
Main Results:
- Comprehensive cardiac rehabilitation (CCR) significantly improved cardiac function: enhanced LVEF (SMD = 0.56), reduced LVEDD (SMD = -0.67), and increased exercise capacity (SMD = 0.82).
- CCR led to a substantial reduction in Major Adverse Cardiovascular Events (MACE) (OR = 0.15).
- The findings were based on a meta-analysis of 16 RCTs, demonstrating robust evidence for CCR's benefits.
Conclusions:
- Patients undergoing first-time PCI for CHD benefit significantly from the integrated approach of five CR strategies.
- Strengthening multidisciplinary cooperation is essential for optimizing clinical outcomes in post-PCI patients.
- CCR represents a vital intervention for improving cardiac function and reducing adverse events in this population.
Background:
Assessment of the influence of the five central cardiac rehabilitation (CR) prescriptions on heart function and cardiovascular complications in individuals with coronary artery disease following percutaneous coronary intervention (PCI).
Methods:
This systematic review and meta-analysis was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of PubMed, Web of Science, Ovid full-text journals database, Embase, CINAHL, Cochrane Library, MEDLINE, CNKI, VIP, SinoMed, and Wanfang data resources, was performed in November 2024. Studies that met the following criteria were included: (i) Population (P): adult individuals (18 years or older) with a confirmed diagnosis of ischemic heart disease using the clinical gold standard "coronary angiography" and undergoing first-time PCI; (ii) Intervention (I): five core cardiac rehabilitation prescriptions; (iii) Control (C): routine rehabilitation guidance/traditional rehabilitation guidance; (iv) Outcomes (O): left ventricular ejection fraction (LVEF)/left ventricular end-diastolic diameter (LVEDD)/six-minute walk distance (6MWD)/Major Adverse Cardiovascular Events (MACE); (v) Study design (S): randomized controlled trials.
Results:
This systematic review and meta-analysis of 16 randomized controlled trials (involving 1808 patients) demonstrates that comprehensive Cardiac Rehabilitation (CCR), integrating exercise training, nutritional counseling, smoking cessation support, psychological intervention, and medication management, yields two key benefits for coronary heart disease (CHD) patients following first-time PCI: (1) significant enhancement of cardiac function evidenced by improved LVEF (standardized mean difference (SMD) = 0.56, 95% confidence interval (CI): 0.33 to 0.79), reduced LVEDD (SMD = -0.67, 95% CI: -0.97 to -0.36), and increased exercise capacity (SMD = 0.82, 95% CI: 0.48 to 1.15); (2) substantial reduction in MACE (odds ratios (OR) = 0.15, 95% CI: 0.09 to 0.24).
Conclusions:
Patients who have undergone first-time PCI for CHD may experience significant advantages from the combined intervention of five CR strategies. Along with adherence to medical therapy and the evolution of medical models, strengthening multidisciplinary cooperation is crucial for optimizing clinical outcomes in patients following coronary interventional procedures.
The Prospero Registration:
CRD42024565139, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024565139.
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