Meta-Analysis of the Effects of Cardiac Rehabilitation on Exercise Tolerance and Cardiac Function in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.

OBJECTIVE

To evaluate the effects of cardiac rehabilitation on exercise tolerance and cardiac function in heart failure patients undergoing cardiac resynchronization therapy (CRT).

METHODS

Randomized controlled trials were initially identified from systematic reviews of the literature about cardiac rehabilitation and heart failure patients with CRT. We undertook updated literature searches of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CBM, CNKI, and Wanfang databases until July 1, 2017. STATA12.0 software was used.

RESULTS

Four randomized controlled studies were included. The total sample size was 157 patients, including 77 in the control group. Cardiac rehabilitation treatment affected the peak VO in heart failure patients with CRT ( =0.491,  = 0%). The results lacked heterogeneity, and the data were merged in a fixed-effects model (WMD = 2.17 ml/kg/min, 95% CI (1.42, 2.92), < 0.001). The peak VO was significantly higher in the cardiac rehabilitation group than in the control group. The sensitivity analysis showed that the results of the meta-analysis were robust. Cardiac rehabilitation treatment affected LVEF in heart failure patients with CRT ( =0.064,  = 63.6%); the heterogeneity among the various research results meant that the data were merged in a random-effects model (WMD = 4.75%, 95% CI (1.53, 7.97), =0.004). The LVEF was significantly higher in the cardiac rehabilitation group than in the control group. The sources of heterogeneity were analyzed, and it was found that one of the studies was the source of significant heterogeneity. After the elimination of that study, the data were reanalyzed, and the heterogeneity was significantly reduced. There were still significant differences in the WMD and 95% CI.

CONCLUSION

Cardiac rehabilitation can improve exercise tolerance and cardiac function in heart failure patients with CRT. Future studies are needed to evaluate whether these beneficial effects of cardiac rehabilitation may translate into an improvement in long-term clinical outcomes among these patients.