Department of Gerontology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Medicine, University of Otago - Christchurch, Christchurch, New Zealand.
Can J Cardiol. 2021 Jan;37(1):162-171. doi: 10.1016/j.cjca.2020.02.072. Epub 2020 Feb 19.
Cardiac rehabilitation is a medically supervised program after coronary events that involves exercise and dietary modification. We evaluated the comparative benefits and harms of cardiac rehabilitation strategies via a network meta-analysis.
We followed a pre-specified protocol (PROSPERO: CRD42018094998). We searched Embase, MEDLINE, and Cochrane Central Register of Randomized Trials databases for randomized controlled trials that evaluated cardiac rehabilitation vs a second form of rehabilitation or standard/usual care in adults after myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or angiography. Risk of bias and evidence quality was evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. Pairwise and Bayesian network meta-analyses were performed for 11 clinical outcomes.
We included 134 randomized controlled trials involving 62,322 participants. Compared with standard care, exercise-only cardiac rehabilitation reduced the odds of cardiovascular mortality (odds ratio [OR], 0.70; 95% credibility interval [CrI], 0.51-0.96; moderate-quality evidence), major adverse cardiovascular events (OR, 0.57; 95% CrI, 0.40-0.78; low-quality evidence), nonfatal myocardial infarction (OR, 0.71; 95% CrI, 0.54-0.93; moderate-quality evidence), all-cause hospitalization (OR, 0.74; 95% CrI, 0.54-0.98; moderate-quality evidence), and cardiovascular hospitalization (OR, 0.69; 95% CrI, 0.51-0.88; moderate-quality evidence). Exercise-only cardiac rehabilitation was associated with lower cardiovascular hospitalization risk relative to cardiac rehabilitation without exercise (OR, 0.68; 95% CrI, 0.48-0.97; moderate-quality evidence).
Cardiac rehabilitation programs containing exercise might provide broader cardiovascular benefits compared with those without exercise.
心脏康复是一种在冠状动脉事件后进行的医学监督计划，包括运动和饮食调整。我们通过网络荟萃分析评估了心脏康复策略的相对益处和危害。
我们遵循了预先指定的方案（PROSPERO：CRD42018094998）。我们在 Embase、MEDLINE 和 Cochrane 中央随机对照试验注册库中搜索了评估心肌梗死后、冠状动脉旁路移植术、经皮冠状动脉介入术或血管造影后心脏康复与第二种康复形式或标准/常规护理相比的随机对照试验。使用 Cochrane 工具和推荐评估、制定和评价（GRADE）分别评估风险偏倚和证据质量。对 11 项临床结局进行了成对和贝叶斯网络荟萃分析。
我们纳入了 134 项随机对照试验，涉及 62322 名参与者。与标准护理相比，仅运动的心脏康复降低了心血管死亡率的几率（比值比[OR]，0.70；95%可信区间[CrI]，0.51-0.96；中等质量证据）、主要不良心血管事件（OR，0.57；95% CrI，0.40-0.78；低质量证据）、非致死性心肌梗死（OR，0.71；95% CrI，0.54-0.93；中等质量证据）、全因住院（OR，0.74；95% CrI，0.54-0.98；中等质量证据）和心血管住院（OR，0.69；95% CrI，0.51-0.88；中等质量证据）。与无运动的心脏康复相比，仅运动的心脏康复与较低的心血管住院风险相关（OR，0.68；95% CrI，0.48-0.97；中等质量证据）。
包含运动的心脏康复计划可能比不包含运动的计划提供更广泛的心血管益处。
