Cardiac rehabilitation and health-related quality of life in preserved ejection fraction heart failure: A meta-analysis.

Aims: The study aims to evaluate the effects of exercise-based cardiac rehabilitation (ExCR) on the health-related quality of life (HRQoL) in people with heart failure preserved ejection fraction (HFpEF).

Methods: This study is a systematic review and meta-analysis. Six bibliographic databases (Medline, Embase, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Cochrane CENTRAL and China National Knowledge Infrastructure database) were searched to April 2024 for randomized controlled trials (RCTs), involving adults with HFpEF undertaking ExCR compared with no exercise control. Subgroup and sensitivity analyses were conducted to explore potential sources of statistical heterogeneity.

Results: Twelve RCTs recruiting a total of 1005 HFpEF patients with a median of 16 weeks follow-up were included. Four trials defined HFpEF as an ejection fraction of ≥45% and eight trials as ≥50%. Compared with control, ExCR participation was associated with improvements in disease-specific HRQoL as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) [weighted mean difference (WMD): -6.72, 95% confidence interval (Cl): -12.00 to -1.44, P = 0.013] and Kansas City Cardiomyopathy Questionnaire (KCCQ) total scores (WMD: 5.34, 95% CI: 1.75 to 8.93, P < 0.0001) and generic HRQoL assessed by Short-Form 36 and EQ-5D. There was evidence (P ≤ 0.05) of greater improvements in MLHFQ total score with ExCR in trials with shorter exercise duration (<60 min/session), the presence of risk of bias, and larger sample size (>45 patients). Included trials were small and demonstrated substantial clinical and statistical heterogeneity with a range of: (1) population definitions (e.g., definition of HFpEF of ≥45% vs. ≥50%, level and nature of comorbidities), (2) ExCR interventions (e.g., exercise only vs. comprehensive CR programmes, different modes and intensity of exercise, centre- and home-based delivery) and (3) methods of HRQoL assessment (e.g., disease specific vs. generic measure).

Conclusions: This meta-analysis of RCT evidence shows that participation in ExCR provides important gains in HRQoL of people with HFpEF. However, the results should be interpreted with caution given the substantial clinical and statistical heterogeneity. Well reported, fully powered RCTs with longer follow-up are needed to confirm these findings.