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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
Contributor(s): Taylor, Rod S (author); Walker, Sarah (author); Smart, Neil A  (author)orcid ; Piepoli, Massimo F (author); Warren, Fiona C (author); Ciani, Oriana (author); O'Connor, Christopher (author); Whellan, David (author); Keteyian, Steven J (author); Coats, Andrew (author); Davos, Constantinos H (author); Dalal, Hasnain M (author); Dracup, Kathleen (author); Evangelista, Lorraine (author); Jolly, Kate (author); Myers, Jonathan (author); McKelvie, Robert S (author); Nilsson, Birgitta B (author); Passino, Claudio (author); Witham, Miles D (author); Yeh, Gloria Y (author); Zwisler, Ann-Dorthe O (author)
Corporate Author: Exercise Training for Chronic Heart Failure (ExTraMATCH II)
Publication Date: 2018-12
Early Online Version: 2018-09-26
DOI: 10.1002/ejhf.1311
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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.
Publication Type: Journal Article
Source of Publication: European Journal of Heart Failure, 20(12), p. 1735-1743
Publisher: John Wiley & Sons Ltd
Place of Publication: United Kingdom
ISSN: 1879-0844
Fields of Research (FoR) 2008: 110201 Cardiology (incl. Cardiovascular Diseases)
110602 Exercise Physiology
Fields of Research (FoR) 2020: 320101 Cardiology (incl. cardiovascular diseases)
Socio-Economic Objective (SEO) 2008: 920103 Cardiovascular System and Diseases
Socio-Economic Objective (SEO) 2020: 200101 Diagnosis of human diseases and conditions
Peer Reviewed: Yes
HERDC Category Description: C1 Refereed Article in a Scholarly Journal
Appears in Collections:Journal Article
School of Science and Technology

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