Cardiac Rehabilitation, Exercise Capacity, and Quality of Life in Heart Failure

Study Questions:

What is the impact of exercise cardiac rehabilitation (ExCR) on health-related quality of life (HRQoL) and exercise capacity in patients with heart failure (HF)?

Methods:

The authors sought to undertake an individual participant data (IPD) meta-analysis to produce a single data set comprising randomized trials where ExCR (≥3 weeks) 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. One- and two-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics including age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, exercise capacity, and HF with reserved ejection fraction (HFrEF) versus HF with preserved EF (HFpEF).

Results:

Data were obtained from 13 trials for 3,990 patients, predominantly (97%) with HFrEF. 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-minute walk test (mean 21.0 m; 95% confidence interval [CI], 1.57-40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement, 5.9; 95% CI, 1.0-10.9; 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.

Perspective:

The degree of improvement in each of the variables is modest with a very large CI (no benefit in peak oxygen consumption overall), but the initial study by the same group demonstrated the positive impact of ExCR on death and hospitalizations. The authors emphasize there was no difference in subgroups that included HFrEF and HFpEF (albeit only 3% had the latter). In fact, the results were nearly identical except there was a much greater improvement in 6-minute walk distance in the group with HFpEF.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Cardiac Rehabilitation, Exercise, Exercise Test, Heart Failure, Oxygen Consumption, Quality of Life, Secondary Prevention, Stroke Volume


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