ABSTRACT
BackgroundParticipation in exercise-based cardiac rehabilitation (ExCR) is consistently a class I recommendation by national and international guidelines for the management of adults with heart failure (HF). However, global access and uptake of ExCR remains poor, a situation that has worsened with the COVID-19 pandemic. The availability of evidence-based alternative modes of ExCR delivery is urgently needed to improve future access.AimTo update the Cochrane review of ExCR in adults with HF and to examine how the impact of ExCR on mortality, hospitalisation, and health-related health quality of life (HRQoL) may vary across modes of ExCR delivery.MethodsLiterature searches were run up to December 2021 with no language restriction. Meta-analyses were stratified according to three modes of ExCR delivery i.e. (1) centre-based programmes, (2), home-based programmes, and (3) hybrid (both centre and home) programmes.ResultsA total of 8,728 HF patients were included from 60 randomised controlled trials. At 12-months follow up, compared with no-exercise control, ExCR reduced the risk of all-cause and HF hospitalisation (relative risk [RR]:0.60;95% Confidence Interval [CI] 0.56 to 0.86;RR: 0.80;CI: 0.60 to 1.06) and improved disease-specific HRQoL (Minnesota Living with HF questionnaire total score mean difference: -7.39;CI -10.30 to -4.47). ExCR had no impact on the risk of mortality (RR:0.93;CI: 0.71 to 1.21). There was no significant difference in the impact of ExCR across outcomes when comparing trials undertaken in a centre, home, or hybrid setting.ConclusionThis latest Cochrane systematic review and meta-analysis update of controlled trials confirms the benefits of ExCR in terms of improved patient HRQoL and reduced risk of hospitalisation. To drive future improvements in access to rehabilitation for HF, our results support the need for health services to provide evidence-based home and hybrid models of ExCR alongside the more traditional centre-based programmes.