Exercise-based cardiac rehabilitation for coronary heart disease

Heran, Balraj S., Chen, Jenny M.H., Ebrahim, Shah, Moxham, Tiffany, Oldridge, Neil, Rees, Karen, Thompson, David R and Taylor, Rod S. (2011) Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 7: CD001800.1-CD001800.92. doi:10.1002/14651858.CD001800.pub2

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Author Heran, Balraj S.
Chen, Jenny M.H.
Ebrahim, Shah
Moxham, Tiffany
Oldridge, Neil
Rees, Karen
Thompson, David R
Taylor, Rod S.
Title Exercise-based cardiac rehabilitation for coronary heart disease
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2011-07
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD001800.pub2
Issue 7
Start page CD001800.1
End page CD001800.92
Total pages 92
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Collection year 2012
Language eng
Formatted abstract
Background
The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health.

Objectives
To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD.

Search strategy
RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009).

Selection criteria
Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography.

Data collection and analysis
Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information.

Main results

This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health-related quality of life using validated measures was there evidence of a significantly higher level of quality of life with exercise-based cardiac rehabilitation than usual care.

Authors' conclusions
Exercise-based cardiac rehabilitation is effective in reducing total and cardiovascular mortality (in medium to longer term studies) and hospital admissions (in shorter term studies) but not total MI or revascularisation (CABG or PTCA). Despite inclusion of more recent trials, the population studied in this review is still predominantly male, middle aged and low risk. Therefore, well-designed, and adequately reported RCTs in groups of CHD patients more representative of usual clinical practice are still needed. These trials should include validated health-related quality of life outcome measures, need to explicitly report clinical events including hospital admission, and assess costs and cost-effectiveness.

Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Created: Tue, 19 Jul 2011, 15:10:21 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work