Exercise-based cardiac rehabilitation for adults with heart failure - 2023 Cochrane systematic review and meta-analysis

TY - JOUR

T1 - Exercise-based cardiac rehabilitation for adults with heart failure - 2023 Cochrane systematic review and meta-analysis

AU - Molloy, Cal D.

AU - Long, Linda

AU - Mordi, Ify R.

AU - Bridges, Charlene

AU - Sagar, Viral A.

AU - Davies, Edward J.

AU - Coats, Andrew J. S.

AU - Dalal, Hasnain

AU - Rees, Karen

AU - Singh, Sally J.

AU - Taylor, Rod S.

N1 - Copyright: © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2023/12

Y1 - 2023/12

N2 - Aims: Despite strong evidence, access to exercise-based cardiac rehabilitation (ExCR) remains low across global healthcare systems. We provide a contemporary update of the Cochrane review randomized trial evidence for ExCR for adults with heart failure (HF) and compare different delivery modes: centre-based, home-based (including digital support), and both (hybrid).Methods and results: Databases, bibliographies of previous systematic reviews and included trials, and trials registers were searched with no language restrictions. Randomized controlled trials, recruiting adults with HF, assigned to either ExCR or a no-exercise control group, with follow-up of ≥6 months were included. Two review authors independently screened titles for inclusion, extracted trial and patient characteristics, outcome data, and assessed risk of bias. Outcomes of mortality, hospitalization, and health-related quality of life (HRQoL) were pooled across trials using meta-analysis at short-term (≤12 months) and long-term follow-up (>12 months) and stratified by delivery mode. Sixty trials (8728 participants) were included. In the short term, compared to control, ExCR did not impact all-cause mortality (relative risk [RR] 0.93; 95% confidence interval [CI] 0.71–1.21), reduced all-cause hospitalization (RR 0.69; 95% CI 0.56–0.86, number needed to treat: 13, 95% CI 9–22), and was associated with a clinically important improvement in HRQoL measured by the Minnesota Living with Heart Failure Questionnaire (MLWHF) overall score (mean difference: −7.39; 95% CI −10.30 to −4.47). Improvements in outcomes with ExCR was seen across centre, home (including digitally supported), and hybrid settings. A similar pattern of results was seen in the long term (mortality: RR 0.87, 95% CI 0.72–1.04; all-cause hospitalization: RR 0.84, 95% CI 0.70–1.01, MLWHF: −9.59, 95% CI −17.48 to −1.50).Conclusions: To improve global suboptimal levels of uptake for HF patients, global healthcare systems need to routinely recommend ExCR and offer a choice of mode of delivery, dependent on an individual patient's level of risk and complexity.

AB - Aims: Despite strong evidence, access to exercise-based cardiac rehabilitation (ExCR) remains low across global healthcare systems. We provide a contemporary update of the Cochrane review randomized trial evidence for ExCR for adults with heart failure (HF) and compare different delivery modes: centre-based, home-based (including digital support), and both (hybrid).Methods and results: Databases, bibliographies of previous systematic reviews and included trials, and trials registers were searched with no language restrictions. Randomized controlled trials, recruiting adults with HF, assigned to either ExCR or a no-exercise control group, with follow-up of ≥6 months were included. Two review authors independently screened titles for inclusion, extracted trial and patient characteristics, outcome data, and assessed risk of bias. Outcomes of mortality, hospitalization, and health-related quality of life (HRQoL) were pooled across trials using meta-analysis at short-term (≤12 months) and long-term follow-up (>12 months) and stratified by delivery mode. Sixty trials (8728 participants) were included. In the short term, compared to control, ExCR did not impact all-cause mortality (relative risk [RR] 0.93; 95% confidence interval [CI] 0.71–1.21), reduced all-cause hospitalization (RR 0.69; 95% CI 0.56–0.86, number needed to treat: 13, 95% CI 9–22), and was associated with a clinically important improvement in HRQoL measured by the Minnesota Living with Heart Failure Questionnaire (MLWHF) overall score (mean difference: −7.39; 95% CI −10.30 to −4.47). Improvements in outcomes with ExCR was seen across centre, home (including digitally supported), and hybrid settings. A similar pattern of results was seen in the long term (mortality: RR 0.87, 95% CI 0.72–1.04; all-cause hospitalization: RR 0.84, 95% CI 0.70–1.01, MLWHF: −9.59, 95% CI −17.48 to −1.50).Conclusions: To improve global suboptimal levels of uptake for HF patients, global healthcare systems need to routinely recommend ExCR and offer a choice of mode of delivery, dependent on an individual patient's level of risk and complexity.

KW - Cardiac rehabilitation

KW - Exercise training

KW - Health-related quality of life

KW - Heart failure

KW - Hospitalization

KW - Mortality

U2 - 10.1002/ejhf.3046

DO - 10.1002/ejhf.3046

M3 - Review article

C2 - 37850321

SN - 1388-9842

VL - 25

SP - 2263

EP - 2273

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 12

ER -