Background Despite major therapeutic advancement in heart failure in the past decade, the syndrome remains a major medical challenge. Mortality rates of heart failure continue to be as high as 20–30% after 3 years. These patients not only suffer from a shortened life expectancy but also poor quality of life due to reduced exercise capacity and frequent hospitalisation. Apart from medical therapy, both European and American guidelines recommend exercise training to improve the quality of life in stable heart failure patients. There are strong evidence to suggest aerobic exercise training is safe, beneficial in improving peak aerobic capacity and quality of life (QoL) and has anti-remodelling effects. However, there is conflicting evidence regarding whether exercise reduces mortality and hospitalisation in patients suffering from heart failure.
Methods We conducted a systematic review and meta-analysis of prospective studies which investigated the efficacy and safety of exercise therapy in stable chronic heart failure patients with reduced ejection fraction. Using a defined-search strategy, electronic databases (MEDLINE and Embase) were searched for randomised controlled trials (RCTs) published between 1946 and 2013. Five eligible studies which investigated the relationship between exercise therapy and all-cause mortality, cardiac mortality and all-cause hospitalisation were identified and appraised using set criteria.
We tested for heterogeneity with the Cochran Q statistic, which was considered significant if p < or =0.10. If significant, a random effect model was used to allow generalisation of the results and sources of heterogeneity were investigated. If there is no significant heterogeneity, then the fixed effect model would be used. Z tests were used to test for overall effect.
Results Combined, these 5 RCTs recruited a total of 2581 patients. 1284 received exercise therapy while 1297 were controls.
Compared with usual care, the pooled risk ratio of all-cause mortality, cardiac mortality and all-cause hospitalisation after exercise therapy in chronic HFrEF patients was 0.95 (95% CI = 0.80–1.14, p = 0.61) (Figure 1); 0.66 (95% CI = 0.34–1.24, p = 0.20) (Figure not shown) and 0.95 (95% CI = 0.90–1.01, p = 0.13) (Figure 2) respectively.
Conclusions Our meta-analysis of RCTs demonstrated that exercise training in patients with stable chronic heart failure due to left ventricular systolic dysfunction is safe, but there is no evidence that exercise training improves all-cause mortality, cardiac mortality or all-cause hospitalisation.
- chronic heart failure
- reduced ejection fraction
- exercise therapy
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