Author + information
- Received August 29, 2018
- Revision received November 27, 2018
- Accepted December 11, 2018
- Published online March 25, 2019.
- Rod S. Taylor, PhDa,∗ (, )@ExeterECG@rod_ExeterECG,
- Sarah Walker, PhDb@Sarah1003Walker,
- Neil A. Smart, PhDc,
- Massimo F. Piepoli, MD, PhDd,
- Fiona C. Warren, PhDe,
- Oriana Ciani, PhDb,f,
- David Whellan, MD, MHSg,
- Christopher O’Connor, MDh,
- Steven J. Keteyian, PhDi,
- Andrew Coats, DMj,
- Constantinos H. Davos, MDk,
- Hasnain M. Dalal, MDb,l,
- Kathleen Dracup, PhDm,
- Lorraine S. Evangelista, PhDn,
- Kate Jolly, PhDo,
- Jonathan Myers, PhDp,
- Birgitta B. Nilsson, PT, PhDq,
- Claudio Passino, MDr,
- Miles D. Witham, PhDs,
- Gloria Y. Yeh, MDt,
- on behalf of the ExTraMATCH II Collaboration
- aInstitute of Health Research, College of Medicine and Health, University of Exeter and Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom
- bInstitute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
- cUniversity of New England, Armidale, New South Wales, Australia
- dCardiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- eExeter Collaboration for Academic Primary Care, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
- fCentre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- gDepartment of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- hDuke Clinical Research Institute, Durham, North Carolina
- iDepartment of Medicine, Henry Ford Hospital, Detroit, Michigan
- jIRCCS, San Raffaele, Pisana, Italy
- kCardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
- lResearch, Development & Innovation, Royal Cornwall Hospital, Truro, United Kingdom
- mSchool of Nursing, University of California San Francisco, San Francisco, California
- nUniversity of California Irvine, Irvine, California
- oInstitute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- pVA Palo Alto Health Care System/Stanford University, Stanford, California
- qDivision of Medicine, Oslo University Hospital and Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- rFondazione G. Monasterio and Scuola Superiore Sant’Anna, Pisa, Italy
- sNIHR Newcastle Biomedical Research Centre, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
- tBeth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts
- ↵∗Address for correspondence:
Prof. Rod Taylor, Institute of Health Research, University of Exeter Medical School, College House, St. Luke’s Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom.
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)
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.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received August 29, 2018.
- Revision received November 27, 2018.
- Accepted December 11, 2018.
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