Exercise-based rehabilitation for heart failure: systematic review and meta-analysis

被引:168
作者
Sagar, Viral A. [1 ]
Davies, Edward J. [2 ]
Briscoe, Simon [3 ]
Coats, Andrew J. S. [4 ]
Dalal, Hasnain M. [5 ]
Lough, Fiona [6 ]
Rees, Karen [7 ]
Singh, Sally [8 ]
Taylor, Rod S. [9 ]
机构
[1] Maidstone Tunbridge Wells NHS Trust, Maidstone, Kent, England
[2] Derriford Hosp, South West Cardiothorac Ctr, Plymouth, Devon, England
[3] Univ Exeter Med Sch, Peninsula Technol Assessment Grp PenTAG, Exeter, Devon, England
[4] Univ East Anglia, Norwich, Norfolk, England
[5] Univ Exeter, Truro & Primary Care Res Grp, Royal Cornwall Hosp Trust, Med Sch,Dept Res & Dev,Knowledge Spa, Truro, England
[6] UCLH NHS Trust, Hatter Inst, London, England
[7] Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry, W Midlands, England
[8] Univ Hosp Leicester NHS Trust, Glenfield Hosp, Ctr Exercise & Rehabil Sci, Leicester, Leics, England
[9] Univ Exeter, Med Sch, Inst Hlth Res, Exeter, Devon, England
来源
OPEN HEART | 2015年 / 2卷 / 01期
关键词
D O I
10.1136/openhrt-2014-000163
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure. Methods: A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control. Results: 33 trials were included with 4740 participants predominantly with a reduced ejection fraction (<40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1 year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: -5.8 points, -9.2 to -2.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow-up, quality or publication date. Conclusions: This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.
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页数:12
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