Cardiac rehabilitation for people with heart disease: An overview of Cochrane systematic reviews

- A contemporary review of the evidence for cardiac rehabilitation (CR) is presented.
- The findings of six Cochrane systematic reviews of 148 RCTs of CR are summarised.
- Exercise-based CR is effective and safe for stable patients with HF or post-MI or PCI.
- We present recommendations for design and conduct of future RCTs and systematic reviews of CR.

IntroductionOverviews are a new approach to summarising evidence and synthesising results from related systematic reviews.ObjectivesTo conduct an overview of Cochrane systematic reviews to provide a contemporary review of the evidence for cardiac rehabilitation (CR), identify opportunities for merging or splitting existing Cochrane reviews, and identify current evidence gaps to inform new review titles.MethodsThe Cochrane Database of Systematic Reviews was searched to identify reviews that address the objectives of this overview. Data presentation is descriptive with tabular presentations of review- and trial-level characteristics and results.ResultsThe six included Cochrane systematic reviews were of high methodological quality and included 148 randomised controlled trials in 97,486 participants. Compared to usual care alone, exercise-based CR reduces hospital admissions and improves patient health related quality of life (HRQL) in low to moderate risk heart failure and coronary heart disease (CHD) patients. At 12 months or more follow-up, there was evidence of some reduction in mortality in patients with CHD. Psychological- and education-based interventions appear to have little impact on mortality or morbidity but may improve HRQL. Home- and centre-based programmes are equally effective in improving HRQL at similar costs. Selected interventions can increase the uptake of CR programmes but evidence to support interventions that improve adherence is weak.ConclusionsThis overview confirms that exercise-based CR is effective and safe in the management of clinically stable heart failure and post-MI and PCI patients. We discuss the implications of this overview on the future direction of the Cochrane CR reviews portfolio.