Cochrane Heart – Rehabilitation Review Coordination Centre
A small team within ESMI support and lead the production of systematic reviews, and overviews of reviews, in the field of cardiac rehabilitation.
Programme Director: Rod Taylor
Programme Coordinator: Linda Long
In 2000, we published our first Cochrane review of cardiac rehabilitation (1) building on the two widely cited meta-analyses by Gerald O’Connor (2) and Neil Oldridge (3) undertaken in late 1980’s. These early systematic reviews focused on the mortality effects of exercise-based rehabilitation after myocardial infarction.
In 2008 with the support a 3-year National Institute of Health Research (NIHR) Programme Grant in collaboration with the Cochrane Heart Group we were able to expand the portfolio of the Cochrane cardiac rehabilitation reviews to six reviews reflecting the comprehensive nature of cardiac rehabilitation intervention (exercise, psychological support and education), the wider population of patients (post-myocardial, post-revascularisation, heart failure) receiving these services, and the broader nature of relevant clinical and policy outcomes (hospital admission, health related quality of life).
These Cochrane reviews have played a pivotal role in informing evidence-based policy both in the United Kingdom and internationally and been cited in a number of key clinical guideline documents including:
- NICE. Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (2010)
- NICE MI – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction (2013)
- Exercise Standards for Testing and Training: A Scientific Statement From the American Heart Association. Fletcher, GF, Ades, PA, Kligfield, P, et al. Circulation 128 (2013):873-934.
- ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Dickstein, Kenneth, et al. European heart journal 29.19 (2008): 2388-2442.
In addition, by identifying current evidence gaps, these reviews have played a role in informing the commissioning of research with two notable examples:
- Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) programme:
REACH-HF aims to develop a new self-help manual for people with heart failure and their caregivers that may help them to manage the condition using the principles of cardiac rehabilitation. The team will then evaluate the clinical effectiveness, cost effectiveness and acceptability of the manual for people with heart failure and their caregivers. - CADENCE:A feasibility study and pilot RCT to establish methods for assessing the acceptability, and clinical and cost-effectiveness of enhanced psychological care (EPC) in cardiac rehabilitation services for patients with new onset depression compared with treatment as usual: CADENCE
- ExTraMATCH II: Exercise-based rehabilitation for chronic heart failure
Exercise Training for Chronic Heart Failure ExTraMATCH II is an international collaboration which aims to undertake a comprehensive review of contemporary RCT evidence in order to investigate the relationship between exercise training in Heart Failure (HF) and exercise capacity. Using individual participant data (IPD) meta-analysis, the information gained from ExTraMATCH II will inform future clinical and policy decision-making on the use of exercise-based interventions in HF.
Jolliffe J, Taylor R, Rees K, Ebrahim S, Oldridge N, Thompson D. A systematic review of the exercise based cardiac rehabilitation for patients with cardiac disease. Cochrane Collaboration, ed. Cochrane Library. Oxford: Update Software, 2000. Volume 4. Cochrane Library of Systematic Reviews
O’Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstaed EM, Paffenbarger RS, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989;80: 234–44.
Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac rehabilitation after myocardial infarction. Combined experience of randomised clinical trials. JAMA 1988;260: 945–50.
Taylor, R.S., Piepoli, M.F., Smart, N., Coats, A.J.S., Ellis, S., Dalal, H., O’Connor, C.M., Warren, F.C., Whellan, D., Ciani, O., and ExTraMATCH II Collaborators. Exercise training for chronic heart failure (ExTraMATCH II): Protocol for an individual participant data meta-analysis. International Journal of Cardiology. 2014;174:683-7.
In the summer of 2013, the University of Exeter Medical School provided an internal core support to facilitate the development, update and expansion of this portfolio of Cochrane cardiac rehabilitation reviews. Since then, we have undertaken an overview of reviews, in order to inform how best to take forward and develop the portfolio. This overview, which provides a “friendly front end” to the reviews in the portfolio, has been published in the Cochrane Library, in the International Journal of Cardiology and Heart.
In addition, the following reviews have recently been updated:
- Exercise based rehabilitation for heart failure
- (evidence up to March 2013)
- Home‐based versus centre‐based cardiac rehabilitation
- Review completed and in editorial (evidence up to March 2013)
- Exercise-based rehabilitation for coronary heart disease
- Review completed and in editorial (evidence up to July 2014)
And the following review is in progress:
- Exercise-based cardiac rehabilitation in post-transplantation recipients
- Review proposal form submitted June 2015
| Title | Authors | Population | Intervention | Comparator | Outcomes |
|---|---|---|---|---|---|
|
Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews
December 2014
|
Lindsey Anderson and Rod S Taylor | Adults aged 18 or over, with heart disease, regardless of aetiology. | Exercise with or without education with or without psychological intervention, delivered to people with heart disease, in a hospital community or a home-based setting |
Varied depending on review question. Included:
|
Mortality, morbidity and health-related quality of life, costs and cost-effectiveness, measures of the uptake of, or adherence to, cardiac rehabilitation and its exercise, education and lifestyle components |
|
Exercise based rehabilitation for heart failure
April 2014
|
Rod S Taylor, Viral A Sagar, Ed J Davies, Simon Briscoe, Andrew JS Coats, Hayes Dalal, Fiona Lough, Karen Rees and Sally Singh | Adults of all ages (> 18 years) with evidence of chronic systolic heart failure. | Exercise-based interventions with six months follow up or longer. |
Usual medical care or placebo. |
Mortality, hospitalisation admissions, morbidity and health-related quality of life |
|
Home‐based versus centre‐based cardiac rehabilitation
(updated and submitted for editorial review)
January 2010
|
Rod S Taylor, Hayes Dalal, Kate Jolly, Tiffany Moxham and Anna Zawada, |
Adults with myocardial infarction, angina or heart failure or who had undergone revascularisation. | Home-based cardiac rehabilitation programmes | Supervised centre-based cardiac rehabilitation. | Mortality and morbidity, health-related quality of life and modifiable cardiac risk factors |
|
Exercise‐based cardiac rehabilitation for coronary heart disease
(updated and submitted for editorial review, April 2014)
July 2011
|
Balraj S Heran, Jenny MH Chen, Shah Ebrahim, Tiffany Moxham, Neil Oldridge , Karen Rees, David R Thompson and Rod S Taylor |
Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography | Exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions | Usual Care | Mortality, morbidity and health-related quality of life |
|
Psychological interventions for coronary heart disease
(currently being updated)
August 2011
|
Ben Whalley, Karen Rees, Philippa Davies, Paul Bennett, Shah Ebrahim, Zulian Liu, Robert West, Tiffany Moxham, David R Thompson and Rod S Taylor | Adults with a specific diagnosis of CHD | Psychological interventions administered by trained staff | Usual care | Total or cardiac-related mortality, cardiac morbidity, depression, and anxiety |
|
Patient education in the management of coronary heart disease
(currently being updated)
December 2011
|
James PR Brown, Alexander M Clark, Hayes Dalal, Karen Welch and Rod S Taylor |
Adults with diagnosis of CHD | Education | Usual Medical Care | Mortality, morbidity, health-related quality of life (HRQoL) and healthcare costs |
|
Promoting patient uptake and adherence in cardiac rehabilitation
June 2014
|
Kunal N Karmali, Philippa Davies, Fiona Taylor, Andrew Beswick, Nicole Martin, Shah Ebrahim |
Adults with myocardial infarction, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, heart failure, angina, or coronary heart disease eligible for cardiac rehabilitation. | Any intervention aimed at increasing uptake or adherence to cardiac rehabilitation or any of its component parts. | Usual Care | Measures of the uptake of, or adherence to, cardiac rehabilitation and its exercise, education and lifestyle components |
CopenHeart
The CopenHeart group are currently leading the following Cochrane cardiac rehabilitation review:
Exercise -based cardiac rehabilitation for adults after heart valve surgery
Kirstine L Sibilitz , Selina K Berg , Lars H Tang , Signe S Risom , Christian Gluud , Jane Lindschou , Lars Kober , Christian Hassager , Rod S Taylor and Ann-Dorthe Zwisler
Exercise-based cardiac rehabilitation for adults with atrial fibrillation
Signe S Risom , Ann-Dorthe Zwisler , Pernille Palm Johansen , Kirstine L Sibilitz , Jane Lindschou , Rod S Taylor , Christian Gluud , Jesper H Svendsen and Selina K Berg
Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator
Kim M Nielsen, Ann-Dorthe Zwisler, Rod S Taylor, Jesper H Svendsen, Jane Lindschou, Lindsey Anderson, Selina K Berg
(Protocol submitted for editorial review)
Professor Neil Oldridge
Professor Neil Oldridge is the Director of Fellowship Research for the cardiology and electrophysiology fellows of Aurora Sinai Medical Center and is responsible for guiding fellows in the development of research protocols and projects and for mentoring and training fellows in the techniques and outcomes of cardiac rehabilitation. Dr. Oldridge teaches a regular research seminar series for fellows with a focus on cardiovascular disease prevention and rehabilitation.