Cardiac rehabilitation for participants with implantable cardiac devices: A systematic review and meta-analysis

Rasha Kaddoura , Hassan Al-Tamimi , Dina Abushanab , Sajad Hayat , Theodoros Papasavvas
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Abstract

Aim

The aim is to discuss efficacy and safety of exercise-based cardiac rehabilitation (CR) programmes in participants with implantable cardiac devices compared with usual care.

Methods

MEDLINE, EMBASE and Cochrane databases were searched from inspection till July 15, 2022. Randomized controlled trials were included if they enrolled adult participants with implantable cardiac devices and tested exercise-based CR interventions in comparison with any control. Risk of bias was assessed, and endpoints data were pooled using random-effects model.

Results

Sixteen randomized trials enrolling 2053 participants were included. Study interventions differed between studies in terms of programme components, setting, exercise intensity, and follow-up. All studies included physical exercise component. In both implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) groups, exercise training in CR programmes improved peak oxygen uptake (VO2) [(mean difference (MD) 2.08 ml/kg/min; 95 % CI: 1.44–2.728, p < 0.0001; I2 = 99 %) and (MD 2.24 ml/kg/min; 95 % CI: 1.43–3.04, p < 0.0001; I2 = 96 %), respectively] and 6-min walk test in ICD group (MD 41.51 m; 95 % CI: 15.19–67.82 m, p = 0.002; I2 = 95 %) compared with usual care. In CRT group, there was no statistically significant improvement in left ventricular ejection fraction change between comparison groups. The results were consistent in subgroup analysis according to high or low-to-moderate exercise intensity for change in peak VO2 and ejection fraction in CRT group. There was no difference in number of ICD shocks between the comparators.

Conclusion

Exercise-based CR programmes appear to be safe when enrolling participants with implantable cardiac devices and leading to favourable functional outcomes.

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植入式心脏装置参与者的心脏康复:系统回顾和荟萃分析
目的讨论与常规护理相比,以运动为基础的心脏康复(CR)计划对植入式心脏设备参与者的疗效和安全性。方法检索了MEDLINE、EMBASE和Cochrane数据库,检索期为2022年7月15日。如果随机对照试验招募了植入式心脏设备的成年参与者,并对基于运动的 CR 干预与任何对照进行了对比测试,则纳入该试验。对偏倚风险进行了评估,并使用随机效应模型对终点数据进行了汇总。不同研究的干预措施在计划内容、环境、运动强度和随访方面存在差异。所有研究都包括体育锻炼部分。在植入式心脏除颤器(ICD)组和心脏再同步化治疗(CRT)组中,CR计划中的运动训练提高了峰值摄氧量(VO2)[(平均差(MD)2.08 ml/kg/min; 95 % CI: 1.44-2.728, p < 0.0001; I2 = 99 %)和(MD 2.24 ml/kg/min; 95 % CI: 1.43-3.04, p < 0.0001; I2 = 96 %)],以及与常规护理相比,ICD 组的 6 分钟步行测试(MD 41.51 m; 95 % CI: 15.19-67.82 m, p = 0.002; I2 = 95 %)。在 CRT 组中,对比组之间的左室射血分数变化没有统计学意义上的显著改善。根据高或中低运动强度对 CRT 组峰值 VO2 和射血分数的变化进行亚组分析,结果是一致的。结论以运动为基础的 CR 项目在招募植入心脏设备的参与者时似乎是安全的,并能带来良好的功能结果。
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