Abstract
Background
In heart failure with reduced left ventricular ejection fraction (HFrEF)
patients the effects of exercise-based cardiac rehabilitation on top of
state-of-the-art pharmacological and device therapy on mortality,
hospitalization, exercise capacity and quality-of-life are not well
established.
Design
The design of this study involved a structured review and meta-analysis.
Methods
Evaluation of randomised controlled trials of exercise-based cardiac
rehabilitation in HFrEF-patients with left ventricular ejection fraction
≤40% of any aetiology with a follow-up of ≥6 months published in 1999 or
later.
Results
Out of 12,229 abstracts, 25 randomised controlled trials including 4481
HFrEF-patients were included in the final evaluation. Heterogeneity in study
population, study design and exercise-based cardiac
rehabilitation-intervention was evident. No significant difference in the
effect of exercise-based cardiac rehabilitation on mortality compared to
control-group was found (hazard ratio 0.75, 95% confidence interval
0.39–1.41, four studies; 12-months follow-up: relative risk 1.29, 95%
confidence interval 0.66–2.49, eight studies; six-months follow-up: relative
risk 0.91, 95% confidence interval 0.26–3.16, seven studies). In addition
there was no significant difference between the groups with respect to
‘hospitalization-for-any-reason’ (12-months follow-up: relative risk 0.79,
95% confidence interval 0.41–1.53, four studies), or
‘hospitalization-due-to-heart-failure’ (12-months follow-up: relative risk
0.59, 95% confidence interval 0.12–2.91, four studies; six-months follow-up:
relative risk 0.84, 95% confidence interval 0.07–9.71, three studies). All
studies show improvement of exercise capacity. Participation in
exercise-based cardiac rehabilitation significantly improved quality-of-life
as evaluated with the Kansas City Cardiomyopathy Questionnaire: (six-months
follow-up: mean difference 1.94, 95% confidence interval 0.35–3.56, two
studies), but no significant results emerged for quality-of-life measured by
the Minnesota Living with Heart Failure Questionnaire (nine-months or more
follow-up: mean difference –4.19, 95% confidence interval –10.51–2.12, seven
studies; six-months follow-up: mean difference –5.97, 95% confidence
interval –16.17–4.23, four studies).
Conclusion
No association between exercise-based cardiac rehabilitation and mortality or
hospitalisation could be observed in HFrEF patients but exercise-based
cardiac rehabilitation is likely to improve exercise capacity and quality of
life.
Collapse