Original articleEffect of Cardiac Rehabilitation Dose on Mortality and Morbidity: A Systematic Review and Meta-regression Analysis
Section snippets
Methods
A protocol was developed and registered in the International Prospective Register of Systematic Reviews (ID No. CRD42016036029).21 The methodology was based on the Cochrane Collaboration handbook.22
Search Results
Figure 1 displays the results of the search and application of inclusion/exclusion criteria. Authors of the primary studies included in Table 1 were contacted if these studies were not eligible for inclusion because of lack of information (ie, hazard ratios reported but not outcome event data; none responded). Ultimately, 33 studies were included (Table 2).
Study Characteristics
Characteristics of each included study are summarized in Table 2. Publication year ranged from 1972 to 2013 (median, 2005). With regard to
Discussion
Results from this first-ever meta-regression with a primary objective of examining CR dose suggest that dose of CCR may impact mortality and morbidity. Although a dose-response association was not observed for many outcomes, results suggested patients with CVD should be prescribed at least 36 sessions to reduce PCI. Results also suggested that patients should be prescribed at least 12 sessions to reduce all-cause mortality, although this recommendation warrants replication of our results
Conclusion
An important association exists between CCR sessions and all-cause mortality as well as PCI. There was 35.0% less PCI when CCR participants were prescribed at least 36 sessions. Overall results suggest a minimum of 12 CCR sessions may be needed to improve clinical outcomes, although greater benefits may be achieved with at least 36. Cardiac rehabilitation guidelines globally should promote prescription of at least this many sessions by all programs. Future studies should examine the effect of
Acknowledgments
We thank Saba Ali and Beatrice Luu for quality assessment and data extraction.
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