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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
Author(s) -
Taylor Rod S.,
Walker Sarah,
Smart Neil A.,
Piepoli Massimo F.,
Warren Fiona C.,
Ciani Oriana,
O'Connor Christopher,
Whellan David,
Keteyian Steven J.,
Coats Andrew,
Davos Constantinos H.,
Dalal Hasnain M.,
Dracup Kathleen,
Evangelista Lorraine,
Jolly Kate,
Myers Jonathan,
McKelvie Robert S.,
Nilsson Birgitta B.,
Passino Claudio,
Witham Miles D.,
Yeh Gloria Y.,
Zwisler AnnDorthe O.
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1311
Subject(s) - medicine , heart failure , ejection fraction , hazard ratio , rehabilitation , confidence interval , proportional hazards model , meta analysis , randomized controlled trial , physical therapy , cardiology
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.