Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials

Aims To undertake an individual patient data (IPD) meta-analysis to assess the impact of exercise-based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation , and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association (NYHA) functional class, ischaemic aetiology, ejection fraction, and exercise capacity.

Methods: Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6-months' follow up or longer, providing IPD time to event on mortality or hospitalisation (all-cause or HF-specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both twostage random effects, and 1-stage fixed effect, models.

Results: IPD was obtained from 18 trials including 3912 patients with reduced ejection fraction HF. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals were wide: all-cause mortality: hazard ratio (HR): 0.83 (95% confidence interval (CI): 0.67 to 1.04), HF-related mortality: HR 0.84 (95% CI: 0.49 to 1.46), all-cause hospitalisation: HR 0.90 (95% CI: 0.76 to 1.06), and HF-related hospitalisation: HR 0.98 (95% CI: 0.72 to 1.35). No strong evidence was found of differential intervention effects across patient characteristics.

Conclusion: ExCR did not have a statistically significant effect on the risk of mortality and hospitalisation in reduced ejection fraction HF. However, uncertainty around effect estimates precludes drawing definitive conclusions.