FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4226404947> ?p ?o ?g. }

• W4226404947 abstract "Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016.To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD.We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021.We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease.We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs).This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness." @default.
• W4226404947 created "2022-05-05" @default.
• W4226404947 creator A5028909185 @default.
• W4226404947 creator A5030122053 @default.
• W4226404947 creator A5031427756 @default.
• W4226404947 creator A5043944967 @default.
• W4226404947 creator A5052174968 @default.
• W4226404947 creator A5057729118 @default.
• W4226404947 creator A5086820712 @default.
• W4226404947 date "2021-11-06" @default.
• W4226404947 modified "2023-10-16" @default.
• W4226404947 title "Exercise-based cardiac rehabilitation for coronary heart disease" @default.
• W4226404947 cites W139012422 @default.
• W4226404947 cites W1433573724 @default.
• W4226404947 cites W1482034755 @default.
• W4226404947 cites W1484454705 @default.
• W4226404947 cites W1485432925 @default.
• W4226404947 cites W1496514257 @default.
• W4226404947 cites W1508421392 @default.
• W4226404947 cites W1521658812 @default.
• W4226404947 cites W1529608064 @default.
• W4226404947 cites W1531098764 @default.
• W4226404947 cites W1565831027 @default.
• W4226404947 cites W1571132953 @default.
• W4226404947 cites W1580357846 @default.
• W4226404947 cites W1587980741 @default.
• W4226404947 cites W162253288 @default.
• W4226404947 cites W1769901 @default.
• W4226404947 cites W1817200870 @default.
• W4226404947 cites W1837281832 @default.
• W4226404947 cites W1848464647 @default.
• W4226404947 cites W1854292761 @default.
• W4226404947 cites W1858915602 @default.
• W4226404947 cites W1870903963 @default.
• W4226404947 cites W1901829674 @default.
• W4226404947 cites W1942710557 @default.
• W4226404947 cites W1957769650 @default.
• W4226404947 cites W1960058022 @default.
• W4226404947 cites W1966067664 @default.
• W4226404947 cites W1966989102 @default.
• W4226404947 cites W1967844524 @default.
• W4226404947 cites W1970628072 @default.
• W4226404947 cites W1970679832 @default.
• W4226404947 cites W1972533662 @default.
• W4226404947 cites W1972798443 @default.
• W4226404947 cites W1973134113 @default.
• W4226404947 cites W1973294765 @default.
• W4226404947 cites W1974455709 @default.
• W4226404947 cites W1975035031 @default.
• W4226404947 cites W1978097916 @default.
• W4226404947 cites W1978149089 @default.
• W4226404947 cites W1979034330 @default.
• W4226404947 cites W1979844092 @default.
• W4226404947 cites W1983289518 @default.
• W4226404947 cites W1985567690 @default.
• W4226404947 cites W1985738915 @default.
• W4226404947 cites W1986566116 @default.
• W4226404947 cites W1988284236 @default.
• W4226404947 cites W1988864835 @default.
• W4226404947 cites W1989249925 @default.
• W4226404947 cites W1989629324 @default.
• W4226404947 cites W1990322019 @default.
• W4226404947 cites W1993302280 @default.
• W4226404947 cites W1994055203 @default.
• W4226404947 cites W1994237673 @default.
• W4226404947 cites W1994361130 @default.
• W4226404947 cites W1994871067 @default.
• W4226404947 cites W1998405955 @default.
• W4226404947 cites W1999046818 @default.
• W4226404947 cites W2000358704 @default.
• W4226404947 cites W2001590911 @default.
• W4226404947 cites W2001626482 @default.
• W4226404947 cites W2004145281 @default.
• W4226404947 cites W2005528454 @default.
• W4226404947 cites W2009334130 @default.
• W4226404947 cites W2010597437 @default.
• W4226404947 cites W2011086865 @default.
• W4226404947 cites W2012079110 @default.
• W4226404947 cites W2013699908 @default.
• W4226404947 cites W2014892421 @default.
• W4226404947 cites W2016195339 @default.
• W4226404947 cites W2017134414 @default.
• W4226404947 cites W2018463134 @default.
• W4226404947 cites W2021945733 @default.
• W4226404947 cites W2021966136 @default.
• W4226404947 cites W2022269779 @default.
• W4226404947 cites W2024214390 @default.
• W4226404947 cites W2030754773 @default.
• W4226404947 cites W2033286858 @default.
• W4226404947 cites W2034057825 @default.
• W4226404947 cites W2037788046 @default.
• W4226404947 cites W2038088754 @default.
• W4226404947 cites W2038823923 @default.
• W4226404947 cites W2039406214 @default.
• W4226404947 cites W2039851261 @default.
• W4226404947 cites W2039936074 @default.
• W4226404947 cites W2040255689 @default.
• W4226404947 cites W2041861516 @default.
• W4226404947 cites W2041951235 @default.
• W4226404947 cites W2042619145 @default.

• next