Exercise-based rehabilitation for heart failure: systematic review and meta-analysis.
Exercise-based rehabilitation for heart failure: systematic review and meta-analysis.
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DOI：
10.1136/openhrt-2014-000163
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发表时间：
2015
期刊：
影响因子：
2.7
通讯作者：
Taylor RS
中科院分区：
文献类型：
--
作者：
Sagar VA;Davies EJ;Briscoe S;Coats AJ;Dalal HM;Lough F;Rees K;Singh S;Taylor RS
更新心力衰竭运动心脏康复（CR）的科克伦系统评价。对随机对照试验进行了系统综述和荟萃分析。检索了MEDLINE、EMBASE和科克伦图书馆，截止日期为2013年1月。如果试验评估了单独运动干预或作为综合CR计划的一部分与无运动控制相比的效果，则纳入随访6个月或更长时间的试验。纳入了33项试验，4740名参与者主要为射血分数降低（<40%）和纽约心脏协会II级和III级。与对照组相比，虽然随访至1年的运动CR组之间的汇总全因死亡率没有差异（风险比（RR）0.93; 95% CI 0.69至1.27，p=0.67），但随访超过1年的试验有降低的趋势（RR 0.88; 0.75至1.02，0.09）。 运动CR降低了总体（RR 0.75; 0.62至0.92，0.005）和心力衰竭特异性住院（RR 0.61; 0.46至0.80，0.0004）的风险，并导致明尼苏达心力衰竭生活问卷的临床重要改善（平均差异：-5.8分，-9.2至-2.4，0.0007）。单变量荟萃回归分析显示，这些益处与运动CR的类型和剂量、随访的试验持续时间、质量或发表日期无关。这项更新的科克伦综述显示，无论CR项目的特征如何，基于运动的CR在住院和健康相关生活质量方面的改善似乎在患者中是一致的，并可能降低长期死亡率。需要对个体受试者数据进行荟萃分析，以提供患者亚组和项目水平特征（例如，运动剂量）对结局重要性的确证性证据。
To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure. A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control. 33 trials were included with 4740 participants predominantly with a reduced ejection fraction (<40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1 year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: −5.8 points, −9.2 to −2.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow- up, quality or publication date. This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.