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Canadian Journal of Cardiology

The Effect of Cardiac Rehabilitation on Health-Related Quality of Life in Patients With Coronary Artery Disease: A Meta-analysis

  • Troy Francis
    Correspondence
    Corresponding author: Troy Francis, Toronto General Hospital, 10th Floor Eaton North, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada. Tel.: +1-416-634-8806; +1-416-340-3459.
    Affiliations
    Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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  • Nader Kabboul
    Affiliations
    Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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  • Valeria Rac
    Affiliations
    Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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  • Nicholas Mitsakakis
    Affiliations
    Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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  • Petros Pechlivanoglou
    Affiliations
    Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Joanna Bielecki
    Affiliations
    Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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  • David Alter
    Affiliations
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Toronto Rehabilitation Institute (TRI), University Health Network, Toronto, Ontario, Canada
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  • Murray Krahn
    Affiliations
    Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Published:November 23, 2018DOI:https://doi.org/10.1016/j.cjca.2018.11.013

      Abstract

      Background

      The clinical effectiveness of cardiac rehabilitation (CR) on health-related quality of life (HRQOL) is an area that has not been consistently explored. The objective of this systematic review was to evaluate the effectiveness of providing any core component of CR on HRQOL domains.

      Methods

      We performed a meta-analysis and meta-regression of randomized controlled trials (RCTs) on the core components of CR. RCTs included adult patients with diagnosed coronary artery disease via angiography, myocardial infarction, angina, or who had undergone coronary revascularization. The Cochrane Library, MEDLINE, EMBASE, CINAHL, SCI-EXPANDED, Psych INFO, and Web of Science were searched from inception to April 27, 2017. Outcomes included overall, physical, emotional, and social HRQOL. Outcomes were reported as standardized mean change (SMC) with 95% confidence intervals (CIs). Effect size changes of 0.2, 0.5, and 0.8 SD units reflect a small, moderate, and large effect, respectively.

      Results

      Forty-nine reports of 41 RCTs with 11,747 patients were included. Summary effect sizes were: overall HRQOL SMC, 0.28 (95% CI, 0.05-0.50), physical HRQOL SMC, 0.47 (95% CI, 0.13-0.81), emotional HRQOL SMC, 0.37 (95% CI, −0.02 to 0.77), and social HRQOL SMC, 0.13 (95% CI, −0.06 to 0.32). Meta-regression revealed type of CR intervention and year of publication as positive statistically significant treatment effect modifiers.

      Conclusions

      Receiving CR was shown to improve HRQOL, with exercise-, nonexercise-, and psychological-based interventions playing a vital role. Although these improvements in HRQOL were modest they still reflect an incremental benefit compared with receiving usual care.

      Résumé

      Contexte

      L’efficacité clinique de la réadaptation cardiaque (RC) sur la qualité de vie liée à la santé (QVLS) est un domaine qui n’a pas été exploré de façon méthodique. L’objectif de cette revue systématique était d’évaluer l’efficacité de l’un ou l’autre des éléments centraux de la RC sur les domaines de la qualité de vie liée à la santé.

      Méthodologie

      Nous avons réalisé une méta-analyse et une méta-régression des essais contrôlés avec répartition aléatoire (ECRA) portant sur les éléments centraux de la RC. Les participants des ECRA étaient des patients adultes ayant reçu un diagnostic de coronaropathie par angiographie, ayant eu un infarctus du myocarde, atteints d’angine ou ayant subi une revascularisation coronarienne. Une recherche a été effectuée dans les bases de données Cochrane Library, MEDLINE, EMBASE, CINAHL, SCI-EXPANDED, Psych INFO et Web of Science de leur date de création au 27 avril 2017. Les paramètres d’évaluation étaient la QVLS globale, physique, émotionnelle et sociale. Les résultats étaient présentés sous la forme de variation moyenne standardisée (VMS) avec intervalles de confiance (IC) à 95 %. Des variations de l’ampleur de l’effet de 0,2, 0,5 et 0,8 unité d’écart type (ET) représentent un effet faible, modéré et important, respectivement.

      Résultats

      Quarante-neuf rapports portant sur 41 ECRA auxquels avaient participé 11 747 patients ont été inclus. En résumé, les variations de l’ampleur de l’effet étaient les suivantes : VMS de la QVLS globale, 0,28 (IC à 95 %, 0,05-0,50), VMS de la QVLS physique, 0,47 (IC à 95 %, 0,13-0,81), VMS de la QVLS émotionnelle, 0,37 (IC à 95 %, −0,02-0,77), et VMS de la QVLS sociale, 0,13 (IC à 95 %, −0,06-0,32). La méta-régression a révélé que le type d’intervention de RC et l’année de publication étaient des modificateurs positifs de l’effet du traitement statistiquement significatifs.

      Conclusions

      Il a été montré que le fait de suivre une RC avait pour conséquence d’améliorer la QVLS, et que les interventions de nature psychologiques, ou encore fondées sur l’activité physique ou sur d’autres éléments que l’activité physique jouent un rôle vital. Ces améliorations de la QVLS, même si elles sont légères, n’en constituent pas moins un avantage supplémentaire par rapport aux soins usuels.
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