Which patients with heart failure benefit most from exercise-based cardiac rehabilitation?

Posted by jchoules

About 1 million people in the UK are living with heart failure, a condition with a range of symptoms, including breathlessness at rest and on exertion, and fatigue. Exercise training, which can be offered as part of a rehabilitation programme, is often used as a means of helping patients with heart failure to manage their condition. Recent reviews of the existing evidence in this area have shown that exercise training helps people with heart failure by improving their health-related quality of life and reducing their need for unplanned hospital admissions. This puts less demand on NHS resources as well as avoiding the inconvenience of a hospital admission for the patient. More than 30 clinical trials of exercise-based rehabilitation in over 4,500 heart failure patients have been performed worldwide over the last 10 to 15 years, including a number of studies in the UK.
Exercise-based rehabilitation is strongly recommended for people with heart failure by the National Institute for Health and Care Excellence (NICE), and American and European clinical guidelines. However, there remains a question as to whether patients with heart failure who have different characteristics, for example, older or younger patients, or patients with less severe or more severe heart failure, benefit equally from such exercise training programmes. Individual studies are often unable to address this question, as the study does not include enough participants with the characteristics of interest. However, by combining information about participants from several studies, we can begin to address this question.
A current study, ExTraMATCH II, led by Professor Rod Taylor, with support from the Primary Care Department (Dr Fiona Warren & Dr Sarah Walker) and the Evidence Synthesis & Modelling for Health Improvement (ESMI) team (Dr Oriana Ciani), is doing just this. The project team includes collaborators from Italy, Australia, the USA, and Denmark, among others. So far we have acquired data from 20 studies conducted in 11 countries, including over 3,600 patients with heart failure.
This project, which began in December 2016, is on track to answer the question of which patient groups most benefit from exercise training in terms of patient survival, hospital admission, exercise capacity, and quality of life. Initial project results are expected to be available in the next few months, and will be reported here on the APEx Blog.
Further information about the ExTraMATCH II programme is available at: http://medicine.exeter.ac.uk/research/healthresearch/primarycare/projects/extramatchii/.
The ExTraMATCH II study is funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.

Dr Fiona Warren and Dr Sarah Walker
May 2017

Share