Exercise-based cardiac rehabilitation for coronary heart disease: the CaReMATCH individual participant data meta-analysis

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AIMS: The effectiveness of exercise-based cardiac rehabilitation (ExCR) for coronary heart disease (CHD) has been debated during the past decade. The objectives of the Cardiac Rehabilitation Meta-Analysis of Trials in people with CHD using individual participant data (IPD) (CaReMATCH) study were to (i) provide contemporary estimates on the effectiveness of ExCR for CHD and (ii) examine potential differential effects of ExCR across subgroups. METHODS AND RESULTS: Individual participant data from randomized controlled trials comparing ExCR with no ExCR controls were pooled. To reflect contemporary ExCR practice, trials had to be published since 2010. The outcomes of all-cause and cardiovascular disease (CVD)-related mortality and hospitalization and health-related quality of life (HRQoL) were analysed. From 30 eligible trials (10 677 participants), IPD were obtained from eight trials (4975 participants, 93.5% post-myocardial infarction). Compared with controls, participation in ExCR resulted in a lower risk for all-cause [hazard ratio (HR) 0.68, 95% confidence interval (CI): 0.53, 0.87] and CVD-related hospitalization (HR 0.62, 95% CI: 0.47, 0.83) and higher HRQoL up to 12 months of follow-up (mean difference in utility index: 0.032, 95% CI: 0.003, 0.061). No differences were found in all-cause and CVD mortality (HR 0.99, 95% CI: 0.74, 1.32; HR 0.80, 95% CI: 0.32, 2.04, respectively). Subgroup analyses showed stronger improvements of HRQoL with ExCR in people with lower HRQoL and lower education level and larger reductions in hospitalization risk in those with a lower left ventricular ejection fraction, lower baseline exercise capacity, beta-blockers use, and with a previous history of CVD. No other subgroup effects were observed. CONCLUSION: Our IPD meta-analysis, reflecting trials published since 2010, highlighted that contemporary ExCR is effective in reducing risk of hospitalization and improving HRQoL in those with CHD. Importantly, we reveal treatment benefits to be robust and consistent across most participant subgroups. Together, these data support the class I recommendation of international clinical guidelines that ExCR should be offered to all people with CHD. REGISTRATION: PROSPERO: CRD42020204988.

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