Key result
Exercise-based cardiac rehab cuts CV hospitalisations ~39% versus usual care, partially mediated by improved HRQoL.
Why the study?
It was unknown whether improvements in health-related quality of life mediated the lower risk of hospitalisation following exercise-based cardiac rehabilitation in people with coronary heart disease.
Does exercise-based cardiac rehabilitation reduce hospitalization risk in people with coronary heart disease, and is this effect mediated by improvements in health-related quality of life?
Does exercise-based cardiac rehabilitation reduce hospitalization risk in people with coronary heart disease, and is this effect mediated by improvements in health-related quality of life?
Exercise-based cardiac rehabilitation reduces 2-year hospitalization risk in patients with coronary heart disease, an effect that is partially mediated by improvements in physical and mental health-related quality of life.
Supports exercise-based cardiac rehabilitation to reduce 2-year hospitalizations in coronary heart disease; reinforces consensus and extends evidence via partial health-related quality of life mediation.
Background Participation in exercise-based cardiac rehabilitation (ExCR) lowers the risk for hospitalisation in people with coronary heart disease. Purpose We investigated whether improvements in health-related quality of life (HRQoL), including physical and mental dimensions, mediated the lower risk of hospitalisation following participation in ExCR in people with coronary heart disease. Methods We pooled individual participant data from 8 randomized trials that randomized patients to ExCR or usual care (CaReMATCH) (ExCR: n=1,973, controls: n=1,986). All trials had to be published since 2010 to reflect contemporary medicine. HRQoL, including mental and physical dimensions, was assessed before and directly following the intervention period, and preceded clinical outcome assessments at 1-year and 2-year follow-up for all-cause and cardiovascular-related hospitalisation. Results Compared to controls, participation in ExCR did not reduce 1-year, but significantly reduced 2-year risk of all-cause (hazard ratio [HR]: 0.77, 95%CI: 0.57 to 1.04; HR: 0.71, 95%CI: 0.54 to 0.92, respectively) and cardiovascular-related hospitalisation (HR: 0.64, 95%CI: 0.44 to 0.94; HR: 0.61, 95%CI: 0.44 to 0.86, respectively). HRQoL significantly mediated the 2-year reductions in risk for all-cause (mediation-effect: -0.0011, 95%CI: -0.0013 to -0.0009, mediation: 7.4%) and cardiovascular-related hospitalisation (mediation-effect: -0.0008, 95%CI: -0.0010 to -0.0007, mediation: 6.2%). Both physical (mediation: all-cause: 5.8%; cardiovascular-related: 4.4%) and mental HRQoL-dimensions (mediation: all-cause: 3.4%; cardiovascular-related: 2.6%) mediated the beneficial effects of ExCR. Conclusion Our data highlights that improvements in overall HRQoL following participation in ExCR, including physical and mental dimensions of HRQoL, may directly improve clinical outcomes.Fig1.Mediation explained Fig2.Mediation by overall HRQoL
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Stens et al. (2025) studied this question. Exercise-based cardiac rehab reduced 2-year all-cause hospitalisation by 29% (HR 0.71) and cardiovascular hospitalisation by 39% (HR 0.61), partially mediated by HRQoL improvements.
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