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

on behalf of the ExTraMATCH II Collaboration

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1735-1743
Number of pages9
JournalEuropean Journal of Heart Failure
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Fingerprint

Meta-Analysis
Hospitalization
Heart Failure
Exercise
Mortality
Confidence Intervals
Cardiac Rehabilitation
Proportional Hazards Models
Sex Characteristics
Uncertainty

Keywords

  • Cardiac rehabilitation
  • Exercise training
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{3e611e8a0ff7445f874dd4a6e45ceb76,
title = "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",
abstract = "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.",
keywords = "Cardiac rehabilitation, Exercise training, Meta-analysis, Systematic review",
author = "{on behalf of the ExTraMATCH II Collaboration} and Taylor, {Rod S.} and Sarah Walker and Smart, {Neil A.} and Piepoli, {Massimo F.} and Warren, {Fiona C.} and Oriana Ciani and Christopher O'Connor and David Whellan and Keteyian, {Steven J.} and Andrew Coats and Davos, {Constantinos H.} and Dalal, {Hasnain M.} and Kathleen Dracup and Lorraine Evangelista and Kate Jolly and Jonathan Myers and McKelvie, {Robert S.} and Nilsson, {Birgitta B.} and Claudio Passino and Witham, {Miles D.} and Yeh, {Gloria Y.} and Zwisler, {Ann Dorthe O.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1002/ejhf.1311",
language = "English (US)",
volume = "20",
pages = "1735--1743",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation

T2 - an individual patient data meta-analysis of randomised trials

AU - on behalf of the ExTraMATCH II Collaboration

AU - Taylor, Rod S.

AU - Walker, Sarah

AU - Smart, Neil A.

AU - Piepoli, Massimo F.

AU - Warren, Fiona C.

AU - Ciani, Oriana

AU - O'Connor, Christopher

AU - Whellan, David

AU - Keteyian, Steven J.

AU - Coats, Andrew

AU - Davos, Constantinos H.

AU - Dalal, Hasnain M.

AU - Dracup, Kathleen

AU - Evangelista, Lorraine

AU - Jolly, Kate

AU - Myers, Jonathan

AU - McKelvie, Robert S.

AU - Nilsson, Birgitta B.

AU - Passino, Claudio

AU - Witham, Miles D.

AU - Yeh, Gloria Y.

AU - Zwisler, Ann Dorthe O.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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.

AB - 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.

KW - Cardiac rehabilitation

KW - Exercise training

KW - Meta-analysis

KW - Systematic review

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U2 - 10.1002/ejhf.1311

DO - 10.1002/ejhf.1311

M3 - Article

VL - 20

SP - 1735

EP - 1743

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 12

ER -