A comparison of individual patient analysis versus pooled study meta-analysis methodologies of exercise training trials in heart failure patients

Abstract

'Background': A fixed effects meta-analysis of ten exercise training in trials heart failure patients was conducted. The aim of this current work was to compare different approaches to meta analysis using the same dataset from the previous work on ten exercise training trials in heart failure patients. 'Methods': The following different meta-analysis techniques were used to analyse the data and compared the effects of exercise training on BNP, NT-pro-BNP and peak VO2 before and after exercise training: (1) Trial level (traditional) level MA i) Follow up (post-exercise training intervention) outcome only. ii) Baseline-follow up difference (2) Patient level MA by Post-Stage ANCOVA i) naive model does not take into account trial level ii) Single Stage iii) Two Stage (3) Post outcome only i) Single stage ii) Pre-post outcome difference Single stage. 'Results': The Individual patient data (IPD) analyses produced smaller effect sizes and 95% confidence intervals compared to conventional meta-analysis. The advantage of the one-stage model is that it allows sub-group analyses, while the two-stage model is considered more robust but limited for sub-analyses. 'Conclusions': Our recommendation is to use one-stage or two-stage ANCOVA analysis, the former allows sub-group analysis, while the latter is considered to be more technically robust.