Impact of exercise rehabilitation on exercise capacity and quality-of-life in heart failure: individual participant meta-analysis

Taylor, R. S. et al. (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), pp. 1430-1443. (doi: 10.1016/j.jacc.2018.12.072) (PMID:30922474)

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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)

Item Type:Articles
Keywords:MLHFQ, QoL, exercise capacity, heart failure, quality-of-life, rehabilitation.
Glasgow Author(s) Enlighten ID:Taylor, Professor Rod
Authors: 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., and Yeh, G. Y.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of the American College of Cardiology
ISSN (Online):1558-3597
Published Online:25 March 2019
Copyright Holders:Copyright © 2019 by the American College of Cardiology Foundation
First Published:First published in Journal of the American College of Cardiology 73(12):1430-1443
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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