6. Exercise‐based cardiac rehabilitation for heart disease.
| Exercise‐based cardiac rehabilitation for heart failure | ||||||
|
Patient or population: people with HF Settings: Intervention: exercise‐based CR | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Exercise‐based CR | |||||
| Total mortality Follow‐up: 6‐12 months | Study population | RR 0.93 (0.69 to 1.27) | 1871 (25 studies) | ⊕⊕⊝⊝ low1,2 | ‐ | |
| 75 per 1000 | 70 per 1000 (52 to 96) | |||||
| Moderate | ||||||
| ‐ | ‐ | |||||
| Total mortality Follow‐up: 12‐120 months | Study population | RR 0.88 (0.75 to 1.02) | 2845 (6 studies) | ⊕⊕⊝⊝ low1,2 | ‐ | |
| 196 per 1000 | 173 per 1000 (147 to 200) | |||||
| Moderate | ||||||
| ‐ | ‐ | |||||
| Hospitalisations Follow‐up: 6‐12 months | Study population | RR 0.75 (0.62 to 0.92) | 1328 (15 studies) | ⊕⊕⊕⊝ moderate1 | ‐ | |
| 227 per 1000 | 170 per 1000 (141 to 209) | |||||
| Moderate | ||||||
| ‐ | ‐ | |||||
| Hospitalisations Follow‐up: 12‐74 months | Study population | RR 0.92 (0.66 to 1.29) | 2722 (5 studies) | ⊕⊝⊝⊝ very low1,2,3 | ‐ | |
| 604 per 1000 | 556 per 1000 (399 to 779) | |||||
| Moderate | ||||||
| ‐ | ‐ | |||||
| Hospitalisations (HF‐specific admissions) Follow‐up: 12‐120 months | Study population | RR 0.61 (0.46 to 0.8) | 1036 (12 studies) | ⊕⊕⊕⊝ moderate1,2 | ‐ | |
| 182 per 1000 | 111 per 1000 (84 to 145) | |||||
| Moderate | ||||||
| ‐ | ‐ | |||||
| HRQoL MLWHF score Follow‐up: 6‐12 months | ‐ | The mean HRQoL in the intervention groups was 5.8 lower (9.21 to 2.44 lower) | ‐ | 1270 (13 studies) | ⊕⊝⊝⊝ very low1,3,4 | ‐ |
| HRQoL All HRQoL measures Follow‐up: 12‐120 months | ‐ | The mean HRQoL in the intervention groups was 0.46 lower (0.66 to 0.26 lower) | ‐ | 3240 (13 studies) | ⊕⊝⊝⊝ very low1,2,3,4 | ‐ |
| HRQoL MLWHF Follow‐up: 6‐120 months | ‐ | The mean HRQoL in the intervention groups was 9.49 lower (17.48 to 1.5 lower) | ‐ | 329 (20 studies) | ⊕⊝⊝⊝ very low1,2,3,4 | ‐ |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CR: cardiac rehabilitation; HF: heart failure; HRQoL: health‐related quality of life; MLWHF: Minnesota Living with Heart Failure questionnaire; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
| 1 Random sequence generation and allocation concealment were poorly described; bias likely. 2 The 95% CIs include both no effect and appreciable benefit or harm (i.e. RR < 0.75 or > 1.25). 3 Moderate heterogeneity (I2 > 50%). 4 Funnel plots or Egger test (or both) suggest evidence of asymmetry. | ||||||