40534
2016
2018
eng
26
418
postprint
1
2018-05-25
2018-05-25
--
The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy
Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event.
Design Structured review and meta-analysis.
Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later.
Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations.
Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.
Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
a systematic review and meta-analysis of randomized and non-randomized studies - the Cardiac Rehabilitation Outcome Study (CROS)
urn:nbn:de:kobv:517-opus4-405346
online registration
European Journal of Preventive Cardiology 23 (2016) Nr. 18, S. 1914–1939 DOI: 10.1177/2047487316671181
CC-BY-NC - Namensnennung, nicht kommerziell 4.0 International
Bernhard Rauch
Constantinos H. Davos
Patrick Doherty
Daniel Saure
Maria-Inti Metzendorf
Annett Salzwedel
Heinz Völler
Katrin Jensen
Jean-Paul Schmid
Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
418
eng
uncontrolled
rehabilitation
eng
uncontrolled
acute coronary syndrome
eng
uncontrolled
coronary bypass grafting
eng
uncontrolled
coronary artery disease
eng
uncontrolled
mortality
eng
uncontrolled
hospital readmission
Medizin und Gesundheit
open_access
Humanwissenschaftliche Fakultät
Referiert
Open Access
Sage
Universität Potsdam
https://publishup.uni-potsdam.de/files/40534/phr418.online.pdf
44722
2016
2016
eng
1914
1939
26
23
review
Sage Publ.
London
Univ Heidelberg; Heinrich-Heine Univ
1
--
--
--
The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS)
Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.
European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
10.1177/2047487316671181
27777324
2047-4873
2047-4881
wos2016:2019
WOS:000387686800001
Rauch, B (reprint author), Inst Herzinfarktforsch Ludwigshafen, Bremserstr 79,Haus M, D-67063 Ludwigshafen, Germany., Rauch.B@t-online.de
Pfizer AG Switzerland; Deutsche Herzstiftung e.V. (German Heart Foundation); Deutsche Gesellschaft fur Pravention und Rehabilitation von Herz-Kreislauferkrankungen e.V. (DGPR; German Society of Cardiovascular Prevention and Cardiac Rehabilitation)
importub
2020-03-22T12:33:02+00:00
filename=package.tar
e0f8c7c055a25007f2316d93045855f7
Bernhard Rauch
Constantinos H. Davos
Patrick Doherty
Daniel Saure
Maria-Inti Metzendorf
Annett Salzwedel
Heinz Völler
Katrin Jensen
Jean-Paul Schmid
eng
uncontrolled
Rehabilitation
eng
uncontrolled
acute coronary syndrome
eng
uncontrolled
coronary bypass grafting
eng
uncontrolled
coronary artery disease
eng
uncontrolled
mortality
eng
uncontrolled
hospital readmission
Referiert
Exzellenzbereich Kognitionswissenschaften
Import