Effect of Cardiac Rehabilitation Dose on Mortality and Morbidity: A Systematic Review and Meta-regression Analysis

医学 荟萃分析 元回归 心肌梗塞 相对风险 内科学 子群分析 梅德林 随机对照试验 优势比 奇纳 置信区间 心理干预 精神科 政治学 法学
作者
Carolina Santiago de Araújo Pio,Susan Marzolini,Maureen Pakosh,Sherry L. Grace
出处
期刊:Mayo Clinic Proceedings [Elsevier]
卷期号:92 (11): 1644-1659 被引量:89
标识
DOI:10.1016/j.mayocp.2017.07.019
摘要

Objective To ascertain the effect of cardiac rehabilitation (CR) dose (ie, duration × frequency/wk; categorized as low [<12 sessions], medium [12-35 sessions], or high [≥36 sessions]) on mortality and morbidity. Methods The Cochrane, CINAHL, EMBASE, PsycINFO, and MEDLINE databases were systematically searched from inception through November 30, 2015. Inclusion criteria included randomized or nonrandomized studies with a minimum CR dose of 4 or higher and presence of a control/comparison group. Citations were considered for inclusion, and data were extracted in included studies independently by 2 investigators. Studies were pooled using random-effects meta-analysis and meta-regression where warranted (covariates included study quality, country, publication year, and diagnosis). Results Of 4630 unique citations, 33 trials were included comparing CR to usual care (ie, no dose). In meta-regression, greater dose was significantly related to lower all-cause mortality (high: −0.77; SE, 0.22; P<.001; medium: −0.80; SE, 0.21; P<.001) when compared with low dose. With regard to morbidity, meta-analysis revealed that dose was significantly associated with fewer percutaneous coronary interventions (high: relative risk, 0.65; 95% CI, 0.50-0.84; medium/low: relative risk, 1.04; 95% CI, 0.74-1.48; between subgroup difference P=.03). This reduction was also significant in meta-regression (high vs medium/low: −0.73; SE, 0.20; P<.001). Publication bias was not evident. No dose-response association was found for cardiovascular mortality, all-cause hospitalization, coronary artery bypass graft surgery, or myocardial infarction. Conclusion A minimum of 36 CR sessions may be needed to reduce percutaneous coronary interventions. Future studies should examine the effect of actual dose of CR, and trials are needed comparing different doses. PROSPERO Registration CRD42016036029.
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