Exercise-based cardiac rehabilitation in patients with heart failure: a meta-analysis of randomised controlled trials between 1999 and 2013
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Exercise-based cardiac rehabilitation in patients with heart failure : a meta-analysis of randomised controlled trials between 1999 and 2013. / Lewinter, Christian; Doherty, Patrick; Gale, Christopher P; Crouch, Simon; Stirk, Lisa; Lewin, Robert J; LeWinter, Martin M; Ades, Philip A; Køber, Lars; Bland, John M.
In: European Journal of Preventive Cardiology, Vol. 22, No. 12, 12.2015, p. 1504-1512.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Exercise-based cardiac rehabilitation in patients with heart failure
T2 - a meta-analysis of randomised controlled trials between 1999 and 2013
AU - Lewinter, Christian
AU - Doherty, Patrick
AU - Gale, Christopher P
AU - Crouch, Simon
AU - Stirk, Lisa
AU - Lewin, Robert J
AU - LeWinter, Martin M
AU - Ades, Philip A
AU - Køber, Lars
AU - Bland, John M
N1 - © The European Society of Cardiology 2014.
PY - 2015/12
Y1 - 2015/12
N2 - BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF.METHODS: This was a systematic review including a meta-analysis of EBCR on all-cause mortality, hospital admission, and standardised exercise capacity using four separate exercise tests in patients with heart failure over a minimum follow-up of six months from January 1999-January 2013. Electronic searches were performed in the databases: Medline, CENTRAL, EMBASE, CINAHL, and PsycINFO constrained to randomised controlled trials (RCTs).RESULTS: A total of 46 separate RCTs qualified for the meta-analysis, which employed conventional methods for binary and continuous data. The relative risk (RR) ratio for hospital admission (12 studies) was significantly reduced (RR ratio 0.65; 95% confidence interval (CI) 0.50-0.84; p = 0.001), but mortality (21 studies) was not (RR ratio 0.88; 95% CI 0.77-1.02; p = 0.08). The standardised exercise capacity (26 studies) showed a standardised mean difference (SMD) in favour of the exercise group as compared with the controls (SMD 0.98, 95% CI 0.59-1.37; p < 0.001). Women and elderly people were less frequently enrolled in the RCTs independent of the outcomes. Heterogeneity was moderate to high in the analysis of hospital admission and the standardised exercise capacity demonstrated through skewedness in their funnel plots.CONCLUSIONS: EBCR in patients with HF is associated with significant improvements in exercise capacity and hospital admission over a minimum of six months follow-up, but not in all-cause mortality.
AB - BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF.METHODS: This was a systematic review including a meta-analysis of EBCR on all-cause mortality, hospital admission, and standardised exercise capacity using four separate exercise tests in patients with heart failure over a minimum follow-up of six months from January 1999-January 2013. Electronic searches were performed in the databases: Medline, CENTRAL, EMBASE, CINAHL, and PsycINFO constrained to randomised controlled trials (RCTs).RESULTS: A total of 46 separate RCTs qualified for the meta-analysis, which employed conventional methods for binary and continuous data. The relative risk (RR) ratio for hospital admission (12 studies) was significantly reduced (RR ratio 0.65; 95% confidence interval (CI) 0.50-0.84; p = 0.001), but mortality (21 studies) was not (RR ratio 0.88; 95% CI 0.77-1.02; p = 0.08). The standardised exercise capacity (26 studies) showed a standardised mean difference (SMD) in favour of the exercise group as compared with the controls (SMD 0.98, 95% CI 0.59-1.37; p < 0.001). Women and elderly people were less frequently enrolled in the RCTs independent of the outcomes. Heterogeneity was moderate to high in the analysis of hospital admission and the standardised exercise capacity demonstrated through skewedness in their funnel plots.CONCLUSIONS: EBCR in patients with HF is associated with significant improvements in exercise capacity and hospital admission over a minimum of six months follow-up, but not in all-cause mortality.
U2 - 10.1177/2047487314559853
DO - 10.1177/2047487314559853
M3 - Review
C2 - 25398703
VL - 22
SP - 1504
EP - 1512
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
SN - 2047-4873
IS - 12
ER -
ID: 155983704