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Exercise-based cardiac rehabilitation reduces CV mortality
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In a systematic review and meta-analysis, exercise-based cardiac rehabilitation reduced CV mortality and risk for hospital admissions, but had no significant effect on overall mortality, MI or revascularization.
Lindsey Anderson, PhD, of the Institute of Health Research at the University of Exeter Medical School, United Kingdom, and colleagues searched the Cochrane Central Register of Controlled Trials and other databases for randomized controlled trials that compared exercise-based cardiac rehabilitation with no-exercise controls after MI, revascularization, or a diagnosis of angina pectoris or CHD.
Sixty-three studies with 14,486 participants were included in the final review. The median follow-up was 12 months. Studies had to report one or more of the following: total or CV mortality; fatal or nonfatal MI; revascularization (CABG or PCI); hospitalizations; health-related quality of life; or costs and cost-effectiveness. Most studies were small, but two large multicenter trials (WHO and RAMIT) were included.
Less than 15% of the patients were women. The median age of patients across all the studies was 56 years. Patients attended the exercise-based cardiac rehabilitation at a hospital/center, at home or a combination of the two settings.
According to the results, exercise-based cardiac rehabilitation led to a reduction in CV mortality (RR = 0.74; 95% CI, 0.64-0.86) and risk for hospital admissions (RR = 0.82; 95% CI, 0.7-0.96). The intervention did not, however, have a significant effect on overall mortality (RR = 0.96; 95% CI, 0.88-1.04), MI (RR = 0.9; 95% CI, 0.79-1.04), CABG (RR = 0.96; 95% CI, 0.8-1.16) or PCI (RR = 0.85; 95% CI, 0.7-1.04). Results from 14 of 20 studies also showed improved quality-of-life outcomes after exercise-based cardiac rehabilitation. Findings on cost-effectiveness of exercise-based cardiac rehabilitation ranged from an increase of $42,535/quality-adjusted life-year to a decrease of $650/quality-adjusted life-year compared with controls.
The researchers noted that the difference observed in overall mortality probably was due to the “number of major advances in medical CHD management, such as the increased use of statins.”
They concluded that their results “support the Class I recommendation of current international clinical guidelines that [exercise-based cardiac rehabilitation] should be offered to CHD patients.”
However, the researchers suggested that “future trials need to pay increased attention to recruitment of patients who are more representative of the broader CHD population, including those at higher risk, with major comorbidities, and also with stable angina. Future trials also need to improve their quality of reporting, particularly in terms of risk of bias, details of the intervention and control, clinical events, [health-related quality of life], and health economic outcomes.”
In an editorial comment, Carl J. Lavie, MD from the department of cardiovascular diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School – The University of Queensland School of Medicine, New Orleans, and colleagues suggested that revamping exercise-based cardiac rehabilitation programs may not only increase participation but may improve overall morality benefits.
“More comprehensive [exercise-based cardiac rehabilitation] models, including home-, Internet-, and community-based programs, are needed to provide alternatives to conventional, medically supervised, facility-based exercise interventions,” Lavie and colleagues wrote. “It is time to ‘rebrand and reinvigorate’ [exercise-based cardiac rehabilitation]. Alternative secondary prevention models do not need to replace conventional [exercise-based cardiac rehabilitation], but they should be used to reach a much larger patient population over an extended duration, that is well beyond the traditional 12-week window.” – by Tracey Romero
Disclosure: Anderson reports receiving funding by the University of Exeter Medical School. Lavie and colleagues report no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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