Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation

an individual-patient data meta-analysis of randomised trials

Rod S . Taylor (Lead / Corresponding author), Sarah Walker, Neil A. Smart, Massimo F. Piepoli, Fiona C. Warren, Oriana Ciani, Christopher M. O'Connor, David Whellan, Steven J. Keteyian, Andrew J. S. Coats, Constantinos H. Davos, Hasnain M. Dalal, Kathleen Dracup, Lorraine Evangelista, Kate Jolly, Jonathan Myers, Robert S. McKelvie, Brigitta B. Nilsson, Claudio Passino, Miles Witham & 2 others Gloria Y. Yeh, Ann-Dorthe Olsen Zwisler

Research output: Contribution to journalArticle

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Abstract

Aims: To undertake an individual patient data (IPD) meta‐analysis to assess the impact of exercise‐based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity.

Methods and results: Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6‐month follow‐up or longer, providing IPD time to event on mortality or hospitalisation (all‐cause or HF‐specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two‐stage random effects and one‐stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all‐cause mortality: hazard ratio (HR) 0.83, 95% CI 0.67–1.04; HF‐specific mortality: HR 0.84, 95% CI 0.49–1.46; all‐cause hospitalisation: HR 0.90, 95% CI 0.76–1.06; and HF‐specific hospitalisation: HR 0.98, 95% CI 0.72–1.35]. No strong evidence was found of differential intervention effects across patient characteristics.

Conclusion: Exercise‐based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.
Original languageEnglish
Pages (from-to)1735-1743
Number of pages9
JournalEuropean Journal of Heart Failure
Volume20
Issue number12
Early online date26 Sep 2018
DOIs
Publication statusPublished - 1 Dec 2018

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Meta-Analysis
Hospitalization
Heart Failure
Exercise
Mortality
Confidence Intervals
Cardiac Rehabilitation
Proportional Hazards Models
Sex Characteristics
Uncertainty

Keywords

  • Cardiac rehabilitation
  • Exercise training
  • Meta-analysis
  • Systematic review

Cite this

Taylor, Rod S . ; Walker, Sarah ; Smart, Neil A. ; Piepoli, Massimo F. ; Warren, Fiona C. ; Ciani, Oriana ; O'Connor, Christopher M. ; Whellan, David ; Keteyian, Steven J. ; Coats, Andrew J. S. ; Davos, Constantinos H. ; Dalal, Hasnain M. ; Dracup, Kathleen ; Evangelista, Lorraine ; Jolly, Kate ; Myers, Jonathan ; McKelvie, Robert S. ; Nilsson, Brigitta B. ; Passino, Claudio ; Witham, Miles ; Yeh, Gloria Y. ; Olsen Zwisler, Ann-Dorthe . / Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation : an individual-patient data meta-analysis of randomised trials. In: European Journal of Heart Failure. 2018 ; Vol. 20, No. 12. pp. 1735-1743.
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title = "Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual-patient data meta-analysis of randomised trials",
abstract = "Aims: To undertake an individual patient data (IPD) meta‐analysis to assess the impact of exercise‐based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity.Methods and results: Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6‐month follow‐up or longer, providing IPD time to event on mortality or hospitalisation (all‐cause or HF‐specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two‐stage random effects and one‐stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all‐cause mortality: hazard ratio (HR) 0.83, 95{\%} CI 0.67–1.04; HF‐specific mortality: HR 0.84, 95{\%} CI 0.49–1.46; all‐cause hospitalisation: HR 0.90, 95{\%} CI 0.76–1.06; and HF‐specific hospitalisation: HR 0.98, 95{\%} CI 0.72–1.35]. No strong evidence was found of differential intervention effects across patient characteristics.Conclusion: Exercise‐based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.",
keywords = "Cardiac rehabilitation, Exercise training, Meta-analysis, Systematic review",
author = "Taylor, {Rod S .} and Sarah Walker and Smart, {Neil A.} and Piepoli, {Massimo F.} and Warren, {Fiona C.} and Oriana Ciani and O'Connor, {Christopher M.} and David Whellan and Keteyian, {Steven J.} and Coats, {Andrew J. S.} and Davos, {Constantinos H.} and Dalal, {Hasnain M.} and Kathleen Dracup and Lorraine Evangelista and Kate Jolly and Jonathan Myers and McKelvie, {Robert S.} and Nilsson, {Brigitta B.} and Claudio Passino and Miles Witham and Yeh, {Gloria Y.} and {Olsen Zwisler}, Ann-Dorthe",
note = "This work is supported by UK National Institute for Health Research funding (HTA 15/80/30).",
year = "2018",
month = "12",
day = "1",
doi = "10.1002/ejhf.1311",
language = "English",
volume = "20",
pages = "1735--1743",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Wiley",
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Taylor, RS, Walker, S, Smart, NA, Piepoli, MF, Warren, FC, Ciani, O, O'Connor, CM, Whellan, D, Keteyian, SJ, Coats, AJS, Davos, CH, Dalal, HM, Dracup, K, Evangelista, L, Jolly, K, Myers, J, McKelvie, RS, Nilsson, BB, Passino, C, Witham, M, Yeh, GY & Olsen Zwisler, A-D 2018, 'Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual-patient data meta-analysis of randomised trials', European Journal of Heart Failure, vol. 20, no. 12, pp. 1735-1743. https://doi.org/10.1002/ejhf.1311

Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation : an individual-patient data meta-analysis of randomised trials. / Taylor, Rod S . (Lead / Corresponding author); Walker, Sarah; Smart, Neil A.; Piepoli, Massimo F.; Warren, Fiona C. ; Ciani, Oriana; O'Connor, Christopher M.; Whellan, David ; Keteyian, Steven J.; Coats, Andrew J. S. ; Davos, Constantinos H. ; Dalal, Hasnain M. ; Dracup, Kathleen ; Evangelista, Lorraine ; Jolly, Kate; Myers, Jonathan ; McKelvie, Robert S.; Nilsson, Brigitta B. ; Passino, Claudio; Witham, Miles; Yeh, Gloria Y. ; Olsen Zwisler, Ann-Dorthe .

In: European Journal of Heart Failure, Vol. 20, No. 12, 01.12.2018, p. 1735-1743.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation

T2 - an individual-patient data meta-analysis of randomised trials

AU - Taylor, Rod S .

AU - Walker, Sarah

AU - Smart, Neil A.

AU - Piepoli, Massimo F.

AU - Warren, Fiona C.

AU - Ciani, Oriana

AU - O'Connor, Christopher M.

AU - Whellan, David

AU - Keteyian, Steven J.

AU - Coats, Andrew J. S.

AU - Davos, Constantinos H.

AU - Dalal, Hasnain M.

AU - Dracup, Kathleen

AU - Evangelista, Lorraine

AU - Jolly, Kate

AU - Myers, Jonathan

AU - McKelvie, Robert S.

AU - Nilsson, Brigitta B.

AU - Passino, Claudio

AU - Witham, Miles

AU - Yeh, Gloria Y.

AU - Olsen Zwisler, Ann-Dorthe

N1 - This work is supported by UK National Institute for Health Research funding (HTA 15/80/30).

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Aims: To undertake an individual patient data (IPD) meta‐analysis to assess the impact of exercise‐based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity.Methods and results: Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6‐month follow‐up or longer, providing IPD time to event on mortality or hospitalisation (all‐cause or HF‐specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two‐stage random effects and one‐stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all‐cause mortality: hazard ratio (HR) 0.83, 95% CI 0.67–1.04; HF‐specific mortality: HR 0.84, 95% CI 0.49–1.46; all‐cause hospitalisation: HR 0.90, 95% CI 0.76–1.06; and HF‐specific hospitalisation: HR 0.98, 95% CI 0.72–1.35]. No strong evidence was found of differential intervention effects across patient characteristics.Conclusion: Exercise‐based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.

AB - Aims: To undertake an individual patient data (IPD) meta‐analysis to assess the impact of exercise‐based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity.Methods and results: Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6‐month follow‐up or longer, providing IPD time to event on mortality or hospitalisation (all‐cause or HF‐specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two‐stage random effects and one‐stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all‐cause mortality: hazard ratio (HR) 0.83, 95% CI 0.67–1.04; HF‐specific mortality: HR 0.84, 95% CI 0.49–1.46; all‐cause hospitalisation: HR 0.90, 95% CI 0.76–1.06; and HF‐specific hospitalisation: HR 0.98, 95% CI 0.72–1.35]. No strong evidence was found of differential intervention effects across patient characteristics.Conclusion: Exercise‐based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.

KW - Cardiac rehabilitation

KW - Exercise training

KW - Meta-analysis

KW - Systematic review

U2 - 10.1002/ejhf.1311

DO - 10.1002/ejhf.1311

M3 - Article

VL - 20

SP - 1735

EP - 1743

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 12

ER -