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:

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.

References

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.