Article

OBJECTIVE: To update the Cochrane systematic review of exercise-based cardiac
rehabilitation (CR) for heart failure. METHODS:
A systematic review and
meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and
the Cochrane Library were searched up to January 2013. Trials with 6 or more
months of follow-up were included if they assessed the effects of exercise
interventions alone or as a component of comprehensive CR programme compared with
no exercise control. RESULTS: 33 trials were included with 4740 participants
predominantly with a reduced ejection fraction (<40%) and New York Heart
Association class II and III. Compared with controls, while there was no
difference in pooled all-cause mortality between exercise CR with follow-up to 1
year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend
towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to
1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92,
0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004)
and resulted in a clinically important improvement in the Minnesota Living with
Heart Failure questionnaire (mean difference: -5.8 points, -9.2 to -2.4, 0.0007).
Univariate meta-regression analysis showed that these benefits were independent
of the type and dose of exercise CR, and trial duration of follow- up, quality or
publication date. CONCLUSIONS: This updated Cochrane review shows that
improvements in hospitalisation and health-related quality of life with
exercise-based CR appear to be consistent across patients regardless of CR
programme characteristics and may reduce mortality in the longer term. An
individual participant data meta-analysis is needed to provide confirmatory
evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.

Langue : ANGLAIS