TY - JOUR
T1 - Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure
T2 - Individual Participant Meta-Analysis
AU - 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 - Whellan, David
AU - O'Connor, Christopher
AU - Keteyian, Steven J.
AU - Coats, Andrew
AU - Davos, Constantinos H.
AU - Dalal, Hasnain M.
AU - Dracup, Kathleen
AU - Evangelista, Lorraine S.
AU - Jolly, Kate
AU - Myers, Jonathan
AU - Nilsson, Birgitta B.
AU - Passino, Claudio
AU - Witham, Miles D.
AU - Yeh, Gloria Y.
N1 - Funding Information:
The authors acknowledge the contribution of patient data from Dr. Rebecca Gary, Dr. Rainer Hambrecht, the late Dr. Romualdo Belardinelli, and the late Dr. Pantaleo Giannuzzi. The authors thank Tim Eames, Exeter Clinical Trials Unit, for his advice and support on data management for this study. This study presents independent research funded by the National Institute for Health Research Health Technology Assessment Programme (NIHR-HTA 15/80/30). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funders peer review process informed the study protocol. The sponsor of the study had no role in data interpretation, or writing of the report. Prof. Taylor and Dr. Dalal are co-chief investigators and Prof. Jolly a co-investigator on an NIHR-funded program grant (RP-PG-1210-12004). Prof. Jolly is funded in part by NIHR CLAHRC West Midlands. Dr. Coats has received personal fees from Actimed, AstraZeneca, Faraday, Gore, Impulse Dynamics, Menarini, Novartis, Nutricia, Resmed, Respicardia, Servier, Stealth Peptides, Verona, and Vifor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2019/4/2
Y1 - 2019/4/2
N2 - Background: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups. Objectives: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. Methods: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics. Results: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups. Conclusions: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170)
AB - Background: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups. Objectives: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. Methods: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics. Results: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups. Conclusions: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170)
KW - MLHFQ
KW - QoL
KW - exercise capacity
KW - heart failure
KW - quality-of-life
KW - rehabilitation
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U2 - 10.1016/j.jacc.2018.12.072
DO - 10.1016/j.jacc.2018.12.072
M3 - Article
C2 - 30922474
AN - SCOPUS:85062963920
VL - 73
SP - 1430
EP - 1443
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 12
ER -