Key result
The CaReMATCH project protocol outlines an individual participant data meta-analysis designed to evaluate the effectiveness of exercise-based cardiac rehabilitation on mortality, hospitalization, and quality of life in patients with coronary heart disease.
Why the study?
The impact of exercise-based cardiac rehabilitation on all-cause mortality in CHD remains uncertain, particularly in contemporary clinical practice.
Does exercise-based cardiac rehabilitation improve all-cause mortality, cardiovascular mortality, hospitalisation, and health-related quality of life in patients with coronary heart disease?
Meta-Analysis
Yes
Does exercise-based cardiac rehabilitation improve all-cause mortality, cardiovascular mortality, hospitalisation, and health-related quality of life in patients with coronary heart disease?
This is a protocol for an individual participant data meta-analysis to evaluate the effectiveness of exercise-based cardiac rehabilitation on mortality and hospitalisation in patients with coronary heart disease.
Does not alter current practice; extends aggregate-data syntheses via planned IPD meta-analysis of cardiac rehabilitation.
BACKGROUND: Exercise-based cardiac rehabilitation (CR) has long been a cornerstone in the secondary prevention of coronary heart disease (CHD). Despite meta-analyses of randomised trials demonstrating a positive impact of CR on cardiovascular mortality, hospitalisation, exercise capacity and health related quality of life, the impact of CR on all-cause mortality remains uncertain, especially in the context of contemporary clinical practice. This CR meta-analysis of trials in patients with coronary heart disease using individual participant data (IPD) (CaReMATCH) seeks to (1) provide definitive estimates of the effectiveness of CR in terms of all-cause mortality, cardiovascular mortality, hospitalisation and health-related quality of life, and (2) determine the influence of individual patient characteristics (e.g. age, sex, risk factors) on the effectiveness of CR to inform a personalised CR-approach. METHODS: Randomised controlled trials will be identified that were performed in the last decade, to ensure that CR was performed in combination with contemporary medical care (2010-2020). For our first aim, outcomes of interest include all cause- and CVD-related mortality and hospitalisations. To answer our second research question, we will collect data on exercise capacity, health-related quality of life, and patient baseline demographic and clinical data. Original IPD will be requested from the authors of all eligible trials; we will check original data and compile a master dataset. IPD meta-analyses will be conducted using a one-step meta-analysis approach where the IPD from all studies are modelled simultaneously whilst accounting for the clustering of participants within studies. DISCUSSION: Findings from CaReMATCH will inform future (inter)national clinical and policy decision-making on the (personalised) application of exercise-based CR for patients with CHD.
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Buckley et al. (2020) conducted a meta-analysis in Coronary heart disease. Exercise-based cardiac rehabilitation vs. Standard medical care and psychosocial and/or educational interventions without structured exercise training was evaluated on All-cause mortality, cardiovascular mortality, hospitalisation, and health-related quality of life. The CaReMATCH project protocol outlines an individual participant data meta-analysis designed to evaluate the effectiveness of exercise-based cardiac rehabilitation on mortality, hospitalization, and quality of life in patients with coronary heart disease.
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