Exercise-based cardiac rehabilitation for patients with coronary heart disease - the CaReMATCH individual patient meta-analysis

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Abstract Introduction Exercise-based cardiac rehabilitation (ExCR) is an integral part of coronary heart disease (CHD) management. Purpose The Cardiac Rehabilitation Meta-Analysis of Trials in patients with CHD using individual patient data (CaReMATCH) initiative has dual aims of: (1) providing contemporary estimates on the effectiveness of ExCR for CHD; (2) examining potential differential effects of ExCR across CHD patient subgroups. Methods Individual patient data from randomized controlled trials comparing ExCR to no ExCR (controls) published since 2010 and with at least 6 months of follow-up were sought. The outcomes of health-related quality of life (HRQoL) (EQ-5D, 15D and SF-6D utility scores [UI]), all-cause and cardiovascular disease (CVD)-related mortality and hospitalization were pooled using one- and two-stage individual patient meta-analysis. Results Out of 30 eligible trials (10,677 patients), 8 trials were analysed (4,975 patients, 92.9% post-myocardial infarction). Compared to controls, participation in ExCR resulted in a reduced risk of all cause (hazard ratio [HR] 0.68, 95% confidence interval [CI]: 0.53 to 0.87) and CVD-related hospitalisation (HR 0.62, 95% CI: 0.46 to 0.83), and improved HRQoL (mean difference in UI: 0.043, 95% CI: 0.021 to 0.064). No differences were seen in all-cause and CVD mortality (HR 1.13, 95% CI: 0.80 to 1.60; 1.41, 95% CI: 0.32 to 6.15 respectively). There was no evidence of a differential effect of ExCR across subgroups apart for HRQoL at follow-up, as larger ExCR benefits were obtained in those with a low education level (UI of low vs high education level: 0.062, 95% CI: 0.026 to 0.10; -0.0129, 95% CI: -0.035 to 0.0093 respectively) and a low baseline HRQoL (per 0.10 increment in baseline UI: -0.0073, 95% CI: -0.014 to -0.00093). Conclusion Reinforcing findings of trial level meta-analyses, our IPD meta-analysis found contemporary ExCR participation to improve HRQoL and reduce risk of hospitalization. Importantly, we reveal little differential treatment effects across patient subgroups, supporting the prescription of ExCR to all patients with CHD to achieve clinical benefit. Figure 1

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