Hua Chen, Huang Wenrui, Chen Zhen, Cao Dongmei, Jia Juan, Chen Xiaomei, Yang Juan, Zhang Limin
The Second Affiliated Hospital of Army Medical University: Xinqiao Hospital, Chongqing, 400037, China.
The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China.
Sci Rep. 2024 Dec 28;14(1):31246. doi: 10.1038/s41598-024-82608-z.
Chronic heart failure (CHF) represents one of the most severe and advanced stages of cardiovascular disease. Despite the critical importance of cardiac rehabilitation (CR) in CHF management, while studies have explored the effectiveness of various CR delivery modes and offered valuable context-specific insights, their relative efficacy remains inconsistent across different patient groups, healthcare environments, and intervention approaches. A clearer understanding requires comprehensive comparisons and in-depth analyses to address these variations. Systematic searches were conducted in databases including Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, up to August 2024. Two researchers independently screened the literature according to strict inclusion criteria, extracted relevant data, and assessed the quality of included studies using Cochrane Collaboration tools and the Jadad scale. Subsequent pairwise and network meta-analyses were performed using statistical software, including Stata 17.0, to present the results graphically. The network meta-analysis included 9,552 articles, with 33 meeting the inclusion criteria and examining eleven different interventions. All interventions outperformed routine care. Combined CR with aerobic exercise and resistance training (HCR [AE + RE]) significantly improved Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores and 6-min walk test (6MWT) performance, and reduced rehospitalization rates [SUCRA = 96%]. Center-based cardiac rehabilitation (CBCR) with high-intensity interval training (HIIT) was the most effective in enhancing left ventricular ejection fraction (LVEF), while CBCR(AE) demonstrated the greatest improvement in peak oxygen uptake (Peak VO) [RR = 3.64, 95% CI: 1.66-7.95]. Our analysis identifies HCR (AE + RE) as the most effective intervention for improving quality of life (MLHFQ), exercise capacity (6MWT), and reducing hospital readmissions. CBCR (HIIT) was optimal for enhancing cardiac function through improved LVEF, while CBCR (AE) effectively boosted peak VO.PROSPERO: CRD42024517039, Review Completed not published.
慢性心力衰竭（CHF）是心血管疾病最严重和最晚期的阶段之一。尽管心脏康复（CR）在CHF管理中至关重要，但虽然已有研究探讨了各种CR实施模式的有效性并提供了有价值的特定背景见解，但其相对疗效在不同患者群体、医疗环境和干预方法中仍不一致。需要进行全面比较和深入分析才能更清楚地理解这些差异。截至2024年8月，我们在包括PubMed、Embase、Cochrane对照试验中央注册库和科学网在内的数据库中进行了系统检索。两名研究人员根据严格的纳入标准独立筛选文献，提取相关数据，并使用Cochrane协作工具和Jadad量表评估纳入研究的质量。随后使用包括Stata 17.0在内的统计软件进行成对和网络荟萃分析，以图形方式呈现结果。网络荟萃分析纳入了9552篇文章，其中33篇符合纳入标准并研究了11种不同的干预措施。所有干预措施均优于常规护理。综合心脏康复与有氧运动和抗阻训练（HCR [AE + RE]）显著改善了明尼苏达心力衰竭生活问卷（MLHFQ）评分和6分钟步行试验（6MWT）表现，并降低了再住院率[累积排序曲线下面积（SUCRA）= 96%]。基于中心的心脏康复（CBCR）结合高强度间歇训练（HIIT）在提高左心室射血分数（LVEF）方面最有效，而CBCR（AE）在峰值摄氧量（Peak VO）方面改善最大[风险比率（RR）= 3.64，95%置信区间（CI）：1.66 - 7.95]。我们的分析确定HCR（AE + RE）是改善生活质量（MLHFQ）、运动能力（6MWT）和降低医院再入院率最有效的干预措施。CBCR（HIIT）通过提高LVEF增强心脏功能效果最佳，而CBCR（AE）有效提高了Peak VO。国际前瞻性系统评价注册库（PROSPERO）：CRD42024517039，综述已完成但未发表。
