Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis.
Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis.
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DOI：
10.1016/j.jacc.2018.12.072
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发表时间：
2019-04-02
影响因子：
24
通讯作者：
ExTraMATCH II Collaboration
中科院分区：
文献类型：
--
作者：
Taylor RS;Walker S;Smart NA;Piepoli MF;Warren FC;Ciani O;Whellan D;O'Connor C;Keteyian SJ;Coats A;Davos CH;Dalal HM;Dracup K;Evangelista LS;Jolly K;Myers J;Nilsson BB;Passino C;Witham MD;Yeh GY;ExTraMATCH II Collaboration
先前的系统评价表明，心力衰竭（HF）患者基于运动的心脏康复（ExCR）对健康相关的生活质量（HRQoL）和运动能力具有有益影响。然而，ExCR 对心力衰竭患者亚组的潜在差异效应尚不确定。作者试图进行个体参与者数据 (IPD) 荟萃分析，以：1) 评估 ExCR 对心力衰竭患者的 HRQoL 和运动能力的影响； 2) 根据一系列患者特征研究 ExCR 的差异效应：年龄、性别、种族、纽约心脏协会功能分级、缺血性病因、射血分数和运动能力。生成了一个数据集，其中包含随机试验，其中 ExCR（持续 3 周或更长时间）与无运动对照组进行比较。每项试验都提供关于 HRQoL 或运动能力（或两者）的 IPD，并进行 6 个月或更长时间的随访。使用一阶段和两阶段荟萃分析模型来研究 ExCR 的整体影响以及 ExCR 与参与者特征之间的相互作用。 IPD 是从 13 项试验中获得的，涉及 3,990 名患者，其中主要 (97%) 患有射血分数降低的 HF。与对照组相比，ExCR在HRQoL和运动能力方面有统计学上的显着差异。在 12 个月的随访中，6 分钟步行测试（平均 21.0 m；95% 置信区间：1.57 至 40.4 m；p = 0.034）和明尼苏达心力衰竭生活评分（平均改善 5.9；95% 置信区间：1.0 至 10.9；p = 0.018）有所改善。没有发现一致的证据表明不同患者亚组的干预效果存在差异。这些结果基于随机试验的 IPD 荟萃分析，证实了 ExCR 对 HRQoL 和运动能力的益处，并支持当前国际临床指南的 I 类建议，即应向所有心力衰竭患者提供 ExCR。 （慢性心力衰竭运动训练 [ExTraMATCH II]：个体参与者数据荟萃分析方案；PROSPERO：国际系统评价数据库 CRD42014007170）。
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. 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. 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. 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. 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).
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