What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart failure with cardiac resynchronization therapy (n=661). Intervention: Exercise rehabilitation vs. Standard medical care without exercise training or advice. Primary outcome: Peak oxygen uptake (peak VO2) (WMD 2.02 ml/kg/min, 95% CI 0.62 to 3.41, p=0.005).

August 21, 2020Open Access

Efficacy and Safety of Exercise Rehabilitation for Heart Failure Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis

Q: What does this research mean for the field?

Exercise rehabilitation significantly improves peak oxygen uptake, left ventricular ejection fraction, and health-related quality of life compared to standard care in heart failure patients with a cardiac resynchronization therapy (CRT) device. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

LYLifang YeUniversity of California, Los Angeles SWShaomei WangYunnan Agricultural University LWLihong WangShihezi University

Key Result

Exercise rehabilitation significantly improved peak oxygen uptake (WMD 2.02 ml/kg/min) and left ventricular ejection fraction compared to standard care in heart failure patients with a CRT device.

Study Design

Type

Meta-Analysis (n=661)

Structured PICO

Does exercise rehabilitation improve exercise capacity, cardiac function, and quality of life in heart failure patients with a CRT device?

Population

661 heart failure patients with a cardiac resynchronization therapy (CRT) device (pooled from 7 RCTs)

Intervention

Exercise rehabilitation (intervention duration of 8 to 24 weeks)

Comparator

Control group (no exercise rehabilitation)

Outcome

Exercise capacity (peak oxygen uptake and exercise duration), left ventricular ejection fraction (LVEF), health-related quality of life (HRQOL), all-cause mortality, and serious adverse eventssurrogate

Exercise rehabilitation is safe and effectively improves exercise capacity, left ventricular ejection fraction, and quality of life in heart failure patients with a CRT device.

Main Result

Effect estimate: WMD 2.02 ml/kg/min (95% CI 0.62 to 3.41)

p-value: p=0.005

Limitations

Relatively few studies were included in the meta-analysis
Most trials were relatively small and reported few clinical events
Possibility of selection bias cannot be ruled out as only published trials were included
Follow-up duration and exercise program duration might be too short for clinical outcomes
Control groups were grouped into a single control group which may have been an oversimplification
Intensity and duration of the exercise training in the included studies varied
Several included studies had a high dropout rate

Abstract

Background: Many heart failure (HF) patients admitted to cardiac rehabilitation (CR) centers have a cardiac resynchronization therapy (CRT) device. However, information about the efficacy and safety of exercise rehabilitation in HF patients with a CRT device is scant. We assessed the effects of exercise rehabilitation in HF patients with a CRT device. Methods and Results: The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, China Biology Medicine, Wanfang, and China National Knowledge Infrastructure databases were searched comprehensively to identify randomized controlled trials (RCTs) published between January 1, 1990 and July 1, 2019 on exercise rehabilitation in HF patients with CRT devices. We identified seven studies published from 2006 to 2019, including 661 patients with an intervention duration of 8 to 24 weeks. Three studies reported all-cause mortality and serious adverse events, and no significant difference was found between exercise rehabilitation patients and controls at the longest available follow‐up (both P＞0.05; both I2=0%). Exercise rehabilitation patients exhibited a higher exercise capacity (peak oxygen uptake: random-effect WMD=2.02 ml/kg/min, 95% CI 0.62 to 3.41, P=0.005, I2=67.4%; exercise duration: fixed-effect WMD=102.34s, 95% CI 67.06 to 137.62, P<0.001, I2=25%) after intervention, despite the significant heterogeneity of studies. Left ventricular ejection fraction (LVEF) was significantly improved in exercise rehabilitation patients compared to that in controls (fixed-effect WMD=3.89%, 95% CI 1.50 to 6.28; P=0.001; I2=48.0%). Due to differences in health-related quality of life (HRQOL) assessment methods, we only pooled data that reported Minnesota Living with Heart Failure Questionnaire scores. Exercise rehabilitation patients exhibited a better HRQOL than controls (fixed-effect WMD=-5.34, 95% CI -10.12 to -0.56; P=0.028; I2=0%). Conclusions: Exercise rehabilitation may restore exercise capacity and cardiac function in HF patients with a CRT device. Furthermore, exercise training was associated with better HRQOL on follow-up.

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