- Background
Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis.
Design
A systematic review and meta-analysis.
Methods
Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included.
Resulte
Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31Background
Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis.
Design
A systematic review and meta-analysis.
Methods
Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included.
Resulte
Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results).
Conclusion
CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.…
MetadatenAuthor details: | Annett SalzwedelORCiDGND, Katrin Jensen, Bernhard Rauch, Patrick Doherty, Maria-Inti MetzendorfORCiD, Matthes Hackbusch, Heinz VöllerORCiDGND, Jean-Paul Schmid, Constantinos H. Davos |
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DOI: | https://doi.org/10.1177/2047487320905719 |
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ISSN: | 2047-4873 |
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ISSN: | 2047-4881 |
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Pubmed ID: | https://pubmed.ncbi.nlm.nih.gov/32089005 |
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Title of parent work (English): | European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology |
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Subtitle (German): | update of the Cardiac Rehabilitation Outcome Study (CROS-II) |
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Publisher: | Oxford Univ. Press |
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Place of publishing: | Oxford |
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Publication type: | Article |
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Language: | English |
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Date of first publication: | 2020/11/01 |
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Publication year: | 2020 |
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Creating corporation: | Univ Heidelberg Heinrich Heine Univ |
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Release date: | 2023/03/23 |
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Tag: | acute coronary; cardiac rehabilitation; cardiac rehabilitation delivery; coronary artery disease; coronary bypass grafting; mortality; syndrome |
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Volume: | 27 |
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Issue: | 16 |
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Article number: | 2047487320905719 |
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Number of pages: | 19 |
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First page: | 1756 |
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Last Page: | 1774 |
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Funding institution: | Pfizer AG Switzerland; Deutsche Herzstiftung eV (German Heart; Foundation); Deutsche Gesellschaft fur Pravention und Rehabilitation von; Herz-Kreislauferkrankungen eV (DGPR; German Society of Cardiovascular; Prevention and Cardiac Rehabilitation); Schweizer Arbeitsgruppe fur; kardiovaskulare Pravention, Rehabilitation und Sportkardiologie (SCPRS; Swiss Working Group for Cardiovascular Prevention, Rehabilitation and; Sports Cardiology) |
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Organizational units: | Humanwissenschaftliche Fakultät / Strukturbereich Kognitionswissenschaften / Department Sport- und Gesundheitswissenschaften |
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DDC classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Peer review: | Referiert |
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Publishing method: | Open Access / Hybrid Open-Access |
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License (German): | CC-BY-NC - Namensnennung, nicht kommerziell 4.0 International |
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