Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: the Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF) : a systematic review and meta-analysis
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 establish...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
1 June 2020
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| In: |
European journal of preventive cardiology
Year: 2020, Volume: 27, Issue: 9, Pages: 929-952 |
| ISSN: | 2047-4881 |
| DOI: | 10.1177/2047487319854140 |
| Online Access: | Resolving-System, lizenzpflichtig, Volltext: https://doi.org/10.1177/2047487319854140 Verlag, lizenzpflichtig, Volltext: https://journals.sagepub.com/doi/10.1177/2047487319854140 
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| Author Notes: | Birna Bjarnason-Wehrens, R. Nebel, K. Jensen, M. Hackbusch, M. Grilli, S. Gielen, B. Schwaab, B. Rauch, for the German Society of Cardiovascular Prevention and Rehabilitation (DGPR) |
| Summary: | 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. |
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| Item Description: | Gesehen am 07.04.2020 |
| Physical Description: | Online Resource |
| ISSN: | 2047-4881 |
| DOI: | 10.1177/2047487319854140 |