Meta-analysis of safety and efficacy on exercise rehabilitation in coronary heart disease patients post revascularization procedure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of exercise rehabilitation in coronary heart disease patients post reascularization procedure.</p><p><b>METHOD</b>We searched the Cochrane Central Register of Controlled Trials (CCRCT), Pubmed, Wanfang, CNKI, CBM and VIP database for randomized controlled trials (RCTs) on exercise rehabilitation for patients with coronary artery disease post percutaneous coronary intervention revascularization or coronary artery bypass grafting. Quality assessment and data collection were conducted by two reviewers independently. The data were analyzed by Review Manager 5.0.</p><p><b>RESULTS</b>A total of 3 474 patients from 16 RCTs were included in this meta-analysis and patients were divided into exercise rehabilitation group (n = 1 425) and control group (n = 2 049). Meta-analysis results showed mortality rate was similar between the two groups (OR = 0.81, 95%CI 0.38-1.69, P > 0.05) and the incidence of major cardiovascular events rate (OR = 0.40, 95%CI 0.24-0.65, P < 0.01) and heart rate [mean difference (MD) = -2.82, 95%CI -4.72--0.92, P < 0.01] were significantly lower while LVEF (MD = 2.24, 95%CI 0.18-4.31, P < 0.05), the exercise metabolic equivalent (MD = 0.94, 95%CI 0.43-1.44, P < 0.01) , anaerobic threshold (MD = 1.83, 95%CI 0.67-3.00, P < 0.01) , and maximum oxygen consumption (MD = 3.22, 95%CI 2.42-4.03, P < 0.01) were significantly higher in exercise rehabilitation group than in control group.</p><p><b>CONCLUSION</b>Exercise rehabilitation does not increase the risk of mortality in patients of coronary heart disease after revascularization and can effectively reduce major cardiovascular events.</p>

Analysis on current status of clinical guidelines for hypertension in the world and evaluation on evidence-based clinical guidelines with Appraisal of Guidelines for Research and Evaluation instrument / 中华老年医学杂志

Objective To assess and analyze the current status of clinical guidelines for hypertension in the world by using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.Methods The clinical guidelines for hypertension were identified and approved by searching China hownet,WANFANG database,PUBMED database,MEDLINE,Embase and related institutions and authorization web site from 1995 to January 2012,and relevant Web sites of agencies and organizations that produce and/or endorse guidelines.Names of the guidelines,published years and organizations,methodology of development and reference number were descriptively analyzed.AGREE instrument was used to evaluate the qualities of latest edited clinical guidelines for hypertension in countries all over the world.Results Nine guidelines were enrolled.The results showed that the hypertension guidelines scored the highest average of 88.4％ for clarity of presentation and reliability field; for applicability fields,scored an average of 86.1％; the scope and goal field scored an average of 83.8％; participants field scored an average of 71.7％; editorial independence field scored an average of 64.1％ ; rigor of development field scored the lowest average of 62.9％.The overall assessment showed that NICE 2011,Canada 2012,ESC 2009,Australia 2010 editions were the positively recommended guidelines,JNC7,Japan 2009,China Taiwan 2010,China 2010,South Africa 2011 editions were the recommended guidelines (still need to supplement and improve).No recommend or uncertain guide was found.Conclusions The quality of the hypertension guidelines is higher in general,but some common deficiency in the rigor of development and editorial independence in Asian and African guidelines formulated by the states still exists.There still exist certain gaps in evidence-based medical requirement.And the contents and quality are needed for further regulating and enhancing.A set of scientific systemic hypertension clinical guidelines evaluation system should be established.