Which modes of cardiac rehabilitation are most effective in adults with heart failure? a Bayesian network meta-analysis

Abstract

Objective Currently, the most effective exercise-based cardiac rehabilitation (CR) modality in adults with heart failure (HF) remains unknown. Thus, our network meta-analysis (NMA) aimed to evaluate the efficacy of different modalities of exercise-based CR in patients with HF.

Methods By searching PubMed, Cochrane Central Register of Controlled Studies (CENTRAL), and Embase, randomized controlled trials (RCTs) assessing the efficacy of various CR treatments on heart failure to May 2022 were obtained. Bayesian NMA was utilized for data analysis and compare the efficacy of various rehabilitation modalities. Assessment of risk of bias (ROB) utilizing the Cochrane Risk of Bias tool for included publications.

Results A total of 8,354 participants from 72 studies were included. Some of the included literature had a high risk of bias. These studies were published between 1990 and 2022, with participants aged 44-81 years and intervention durations ranging from 8 to 48 weeks. In accordance with the Bayesian NMA model, following CR methods have the highest ranking compared to usual care: cardiac telerehabilitation (CTR) for health-related quality of life (HR-QOL) [surface under the cumulative ranking (SUCRA)=84.48%; standard mean difference (SMD)=-0.82, Credible interval (CrI) -1.32, -0.33)], center-based cardiac rehabilitation (CBCR) for peak oxygen uptake (peakVO2)[SUCRA=78.46%; mean difference (MD)=2.48, CrI 1.73, 3.24], CBCR for 6-minute walk test (6-min WT) [SUCRA=99.99%; MD=39.89, CrI 29.62, 50.52].

Conclusion The results show that CTR is the most effective treatment for improving HR-QOL for patients with HF. The results need to be interpreted with care. This evidence could be considered by clinicians when recommending CR to patients with HF to achieve better outcomes.