Taylor, Rod S

Walker, Sarah

Smart, Neil A

Piepoli, Massimo F

Warren, Fiona C

Ciani, Oriana

Whellan, David

O'Connor, Christopher

Keteyian, Steven J

Coats, Andrew

Davos, Constantinos H

Dalal, Hasnain M

Dracup, Kathleen

Evangelista, Lorraine S

Jolly, Kate

Myers, Jonathan

Nilsson, Birgitta B

Passino, Claudio

Witham, Miles D

Yeh, Gloria Y

2019-04-02

<b>Background</b> 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.<br/><b>Objectives</b> 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.<br/><b>Methods</b> 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.<br/><b>Results</b> 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.<br/><b>Conclusions</b> 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)

Journal of the American College of Cardiology, 73(12), p. 1430-1443

1558-3597

0735-1097

30922474

https://hdl.handle.net/1959.11/29502

Elsevier Inc

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

Journal Article

Publication