Anderson L J, Taylor R S
Exeter Cochrane Cardiac Rehabilitation Review Group, Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom.
Exeter Cochrane Cardiac Rehabilitation Review Group, Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom.
Int J Cardiol. 2014 Dec 15;177(2):348-61. doi: 10.1016/j.ijcard.2014.10.011. Epub 2014 Nov 15.
Overviews are a new approach to summarising evidence and synthesising results from related systematic reviews.
To 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.
The 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.
The 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.
This 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.
概述是一种总结证据和综合相关系统评价结果的新方法。
对Cochrane系统评价进行概述，以提供关于心脏康复（CR）证据的当代综述，确定合并或拆分现有Cochrane综述的机会，并识别当前的证据空白以指导新的综述主题。
检索Cochrane系统评价数据库以识别符合本概述目标的综述。数据呈现采用描述性方式，以表格形式展示综述和试验水平的特征及结果。
纳入的六项Cochrane系统评价方法学质量较高，包括针对97486名参与者的148项随机对照试验。与单纯常规治疗相比，基于运动的心脏康复可减少低至中度风险心力衰竭和冠心病（CHD）患者的住院次数，并改善患者与健康相关的生活质量（HRQL）。在12个月或更长时间的随访中，有证据表明冠心病患者的死亡率有所降低。基于心理和教育的干预措施似乎对死亡率或发病率影响不大，但可能改善健康相关生活质量。基于家庭和中心的项目在以相似成本改善健康相关生活质量方面同样有效。选定的干预措施可提高心脏康复项目的参与率，但支持改善依从性干预措施的证据薄弱。
本概述证实基于运动的心脏康复在临床稳定的心力衰竭以及心肌梗死和经皮冠状动脉介入治疗后患者的管理中是有效且安全的。我们讨论了本概述对Cochrane心脏康复综述系列未来方向的影响。
