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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 potentialBackground 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.show moreshow less

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Metadaten
Author:Bernhard Rauch, Constantinos H. Davos, Patrick Doherty, Daniel Saure, Maria-Inti Metzendorf, Annett SalzwedelORCiDGND, Heinz VöllerORCiDGND, Katrin Jensen, Jean-Paul Schmid
URN:urn:nbn:de:kobv:517-opus4-405346
Parent Title (English):Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
Subtitle (English):a systematic review and meta-analysis of randomized and non-randomized studies - the Cardiac Rehabilitation Outcome Study (CROS)
Series (Serial Number):Postprints der Universität Potsdam : Humanwissenschaftliche Reihe (418)
Document Type:Postprint
Language:English
Date of first Publication:2018/05/25
Year of Completion:2016
Publishing Institution:Universität Potsdam
Release Date:2018/05/25
Tag:acute coronary syndrome; coronary artery disease; coronary bypass grafting; hospital readmission; mortality; rehabilitation
Issue:418
Pagenumber:26
Source:European Journal of Preventive Cardiology 23 (2016) Nr. 18, S. 1914–1939 DOI: 10.1177/2047487316671181
Organizational units:Humanwissenschaftliche Fakultät
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Peer Review:Referiert
Publication Way:Open Access
Grantor:Sage
Licence (German):License LogoCreative Commons - Namensnennung, Nicht kommerziell 4.0 International