Key result
Exercise-based cardiac rehabilitation for stable angina had an uncertain effect on all-cause mortality but moderately improved short-term exercise capacity.
Why the study?
The effects of exercise-based cardiac rehabilitation in patients with stable angina needed systematic assessment across randomized trials.
Does exercise-based cardiac rehabilitation improve clinical outcomes and exercise capacity in adults with stable angina?
Meta-Analysis (n=581)
Randomized trials
Does exercise-based cardiac rehabilitation improve clinical outcomes and exercise capacity in adults with stable angina?
Exercise-based cardiac rehabilitation improves short-term exercise capacity in patients with stable angina, but its impact on mortality and morbidity remains uncertain due to low-quality evidence.
Answers are grounded in this paper and cite their sources.
Uncertainty around mortality reduction cautions against relying on cardiac rehabilitation for survival gains in stable angina; leaves open whether larger trials confirm hard-endpoint benefits.
Objective: A systematic review was undertaken to assess the effects of exercise-based cardiac rehabilitation (CR) for patients with stable angina. Methods: Databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL) were searched up to October 2017, without language restriction. Randomised trials comparing CR programmes with no exercise control in adults with stable angina were included. Where possible, study outcomes were pooled using meta-analysis. Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of evidence. The protocol was published on the Cochrane Database of Systematic Reviews. Results: Seven studies (581 patients), with a median of 12-month follow-up, were included. The effect of exercise-based CR on all-cause mortality (risk ratio (RR) 1.01, 95 % CI: 0.18 to 5.67), acute myocardial infarction (RR 0.33, 95% CI: 0.07 to 1.63) and cardiovascular-related hospital admissions (RR 0.14, 95% CI: 0.02 to 1.1) relative to control were uncertain. We found low-quality evidence that exercise-based CR results in a moderate improvement in exercise capacity (standard mean difference 0.45, 95% CI: 0.20 to 0.70). There was limited and very low-quality evidence for the effect of exercise-based CR on health-related quality of life (HRQoL), adverse events and costs. No data were identified on cost-effectiveness or return to work. Conclusions: Exercise-based CR may improve the short-term exercise capacity of patients with stable angina pectoris. Well-designed randomised controlled trials are needed to definitely determine the impact of CR on outcomes including mortality, morbidity, HRQoL, and costs in the population of patients with stable angina receiving contemporary medical therapy.
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Long et al. (2019) conducted a meta-analysis in Stable angina (n=581). Exercise-based cardiac rehabilitation vs. No exercise control was evaluated on All-cause mortality (RR 1.01, 95% CI 0.18 to 5.67). Exercise-based cardiac rehabilitation for stable angina had an uncertain effect on all-cause mortality but moderately improved short-term exercise capacity.
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