Anderson Lindsey, Taylor Rod S
Institute of Health Research, University of Exeter edical School, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK.
Cochrane Database Syst Rev. 2014 Dec 12;2014(12):CD011273. doi: 10.1002/14651858.CD011273.pub2.
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 delivery of cardiac rehabilitation, to identify opportunities for merging or splitting existing Cochrane reviews, and to identify current evidence gaps to inform new cardiac rehabilitation systematic review titles.
We searched The Cochrane Database of Systematic Reviews (2014, Issue 10) to identify systematic reviews that addressed the objectives of this overview. We assessed the quality of included reviews using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) measurement tool and the quality of the evidence for reported outcomes using the GRADE framework. The focus of the data presentation was descriptive with detailed tabular presentations of review level and trial level characteristics and results.
We found six Cochrane systematic reviews and judged them to be of high methodological quality. They included 148 randomised controlled trials (RCTs) in 98,093 participants. Compared with usual care alone, the addition of exercise-based cardiac rehabilitation in low-risk people after myocardial infarction or percutaneous coronary intervention or with heart failure appeared to have no impact on mortality, but did reduce hospital admissions and improved health-related quality of life. Psychological- and education-based interventions alone appeared to have little or no impact on mortality or morbidity but may have improved health-related quality of life. Home- and centre-based programmes were equally effective in improving quality of life outcomes at similar healthcare costs. Selected interventions can increase the uptake of cardiac rehabilitation programmes whilst there is currently only weak evidence to support interventions that improve adherence to cardiac rehabilitation programmes. The quality of the primary RCTs in the included systematic reviews was variable, and limitations in the methodological quality of the RCTs led to downgrading of the quality of the evidence, which varied widely by review and by outcome.
AUTHORS' CONCLUSIONS: Exercise-based cardiac rehabilitation is an effective and safe therapy to be used in the management of clinically stable people following myocardial infarction or percutaneous coronary intervention or who have heart failure. Future RCTs of cardiac rehabilitation need to improve their reporting methods and reflect the real world practice better including the recruitment of higher risk people and consideration of contemporary models of cardiac rehabilitation delivery, and identify effective interventions for enhancing adherence to rehabilitation.
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实施证据的当代综述，确定合并或拆分现有Cochrane评价的机会，并识别当前的证据空白，为新的心脏康复系统评价题目提供信息。
我们检索了Cochrane系统评价数据库（2014年第10期），以识别针对本概述目标的系统评价。我们使用修订的多重系统评价评估（R-AMSTAR）测量工具评估纳入评价的质量，并使用GRADE框架评估报告结局的证据质量。数据呈现的重点是描述性的，详细以表格形式展示评价水平、试验水平的特征和结果。
我们发现了六项Cochrane系统评价，并判定它们具有较高的方法学质量。它们纳入了98093名参与者的148项随机对照试验（RCT）。与单纯常规治疗相比，在心肌梗死或经皮冠状动脉介入治疗后或患有心力衰竭的低风险人群中增加基于运动的心脏康复，似乎对死亡率没有影响，但确实减少了住院次数并改善了与健康相关的生活质量。单独的基于心理和教育的干预似乎对死亡率或发病率几乎没有影响，但可能改善了与健康相关的生活质量。基于家庭和中心的项目在以相似的医疗成本改善生活质量结局方面同样有效。选定的干预措施可以提高心脏康复项目的参与率，而目前仅有薄弱证据支持改善心脏康复项目依从性的干预措施。纳入的系统评价中主要RCT的质量参差不齐，RCT方法学质量的局限性导致证据质量降级，不同评价和结局的证据质量差异很大。
基于运动的心脏康复是一种有效且安全的治疗方法，可用于管理心肌梗死或经皮冠状动脉介入治疗后临床稳定的人群或患有心力衰竭的人群。未来心脏康复的RCT需要改进其报告方法，更好地反映现实世界的实践，包括招募高风险人群和考虑当代心脏康复实施模式，并确定增强康复依从性的有效干预措施。
