TY - JOUR
T1 - Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease
T2 - Cochrane Systematic Review and Meta-Analysis
AU - Anderson, Lindsey
AU - Oldridge, Neil
AU - Thompson, David R
AU - Zwisler, Ann-Dorthe
AU - Rees, Karen
AU - Martin, Nicole
AU - Taylor, Rod S
N1 - Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2016/1/5
Y1 - 2016/1/5
N2 - BACKGROUND: Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR).OBJECTIVES: The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD.METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers.RESULTS: A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects.CONCLUSIONS: This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.
AB - BACKGROUND: Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR).OBJECTIVES: The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD.METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers.RESULTS: A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects.CONCLUSIONS: This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.
KW - Coronary Disease/mortality
KW - Exercise
KW - Humans
KW - Quality of Life
KW - Treatment Outcome
U2 - 10.1016/j.jacc.2015.10.044
DO - 10.1016/j.jacc.2015.10.044
M3 - Review
C2 - 26764059
SN - 0735-1097
VL - 67
SP - 1
EP - 12
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -