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Review
. 2018 Dec;20(12):1735-1743.
doi: 10.1002/ejhf.1311. Epub 2018 Sep 26.

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

Rod S Taylor  1 , Sarah Walker  1 , Neil A Smart  2 , Massimo F Piepoli  3 , Fiona C Warren  1 , Oriana Ciani  1   4 , Christopher O'Connor  5 , David Whellan  6 , Steven J Keteyian  7 , Andrew Coats  8 , Constantinos H Davos  9 , Hasnain M Dalal  1 , Kathleen Dracup  10 , Lorraine Evangelista  11 , Kate Jolly  12 , Jonathan Myers  13 , Robert S McKelvie  14 , Birgitta B Nilsson  15 , Claudio Passino  16 , Miles D Witham  17 , Gloria Y Yeh  18 , Ann-Dorthe O Zwisler  19 ; ExTraMATCH II Collaboration
Affiliations
Review

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

Rod S Taylor et al. Eur J Heart Fail. 2018 Dec.

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.

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Conflict of interest statement

Conflict of interest: All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram. HF, heart failure; IPD, individual patient data; RCT, randomised controlled trial.
Figure 2
Figure 2
Effect of exercise-based cardiac rehabilitation on mortality and hospitalisation across patient subgroups. (A) All-cause mortality. (B) Heart failure-specific mortality. (C) All-cause hospitalisation. (D) Heart failure-specific hospitalisation. CI, confidence interval.
Figure 3
Figure 3
Effect of exercise-based cardiac rehabilitation on mortality and hospitalisation across patient subgroups. (A) All-cause mortality. (B) Heart failure-specific mortality. (C) All-cause hospitalisation. (D) Heart failure-specific hospitalisation. CI, confidence interval; HF, heart failure; HR, hazard ratio; NYHA, New York Heart Association; VO2, oxygen uptake.
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