Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis.

Authors

• Rod S Taylor
• Sarah Walker
• Neil A Smart
• Massimo F Piepoli
• Fiona C Warren
• Oriana Ciani
• David Whellan
• Christopher O'Connor
• Steven J Keteyian
• Andrew Coats
• Constantinos H Davos
• Hasnain M Dalal
• Kathleen Dracup
• Lorraine S Evangelista
• Kate Jolly
• Jonathan Myers
• Birgitta B Nilsson
• Claudio Passino
• Miles D Witham
• Gloria Y Yeh

Publication/Presentation Date

4-2-2019

Abstract

BACKGROUND: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups.

OBJECTIVES: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity.

METHODS: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics.

RESULTS: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups.

CONCLUSIONS: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170).

Volume

73

Issue

12

First Page

1430

Last Page

1443

ISSN

1558-3597

Published In/Presented At

Taylor, R. S., Walker, S., Smart, N. A., Piepoli, M. F., Warren, F. C., Ciani, O., Whellan, D., O'Connor, C., Keteyian, S. J., Coats, A., Davos, C. H., Dalal, H. M., Dracup, K., Evangelista, L. S., Jolly, K., Myers, J., Nilsson, B. B., Passino, C., Witham, M. D., Yeh, G. Y., … ExTraMATCH II Collaboration (2019). Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis. Journal of the American College of Cardiology, 73(12), 1430–1443. https://doi.org/10.1016/j.jacc.2018.12.072

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

30922474

Department(s)

Administration and Leadership

Document Type

Article