PMID- 28727672
OWN - NLM
STAT- MEDLINE
DCOM- 20180716
LR  - 20181202
IS  - 1932-751X (Electronic)
IS  - 1932-7501 (Linking)
VI  - 37
IP  - 6
DP  - 2017 Nov
TI  - Cardiac Rehabilitation in Patients With Left Ventricular Assist Device: A 
      SYSTEMATIC REVIEW AND META-ANALYSIS.
PG  - 390-396
LID - 10.1097/HCR.0000000000000254 [doi]
AB  - PURPOSE: Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to 
      improve functional capacity in heart failure (HF). However, there are limited 
      data on the effect of EBCR in patients with advanced HF and left ventricular 
      assist devices (LVADs). This meta-analysis sought to evaluate the effects of EBCR 
      on functional capacity in patients with LVAD. METHODS: PubMed, Web of Science, 
      CINAHL, and Cochrane Library databases were searched for randomized studies 
      assessing the impact of EBCR in patients following LVAD implantation compared 
      with standard therapy (ST). Using pre-defined criteria, appropriate studies were 
      identified and selected. Data from selected studies were extracted in a 
      standardized fashion and a meta-analysis was performed using a random-effects 
      model with DerSimonian Liard weighting. Analysis employed weighted mean 
      difference (WMD) as the effect size and intention-to-treat (ITT) principle. Study 
      quality, publication bias, and heterogeneity were assessed. RESULTS: Six trials 
      with a total of 183 patients (EBCR: 125; ST: 58) were identified. Mean age was 51 
      years and 83% were males. The initiation of EBCR varied from LVAD implantation 
      during the index hospitalization to 10 mo post-LVAD implantation. The median 
      rehabilitation period ranged from 6 to 10 wk. Exercise-based cardiac 
      rehabilitation was associated with improved peak oxygen uptake ((Equation is 
      included in full-text article.)O2) in all trials. Quantitative analysis was 
      performed on 3 randomized studies involving 61 patients (EBCR = 39, ST = 22). 
      Exercise-based cardiac rehabilitation was associated with significantly greater 
      peak (Equation is included in full-text article.)O2 (WMD: 3.00 mL/kg/min; 95% CI: 
      0.64-5.35, P = .001). Similarly, 6-minute walk distance (6MWD) showed 
      significantly greater improvement in the EBCR group than in the ST group (WMD: 
      60.06 m; 95% CI, 22.61-97.50, P = .002). Heterogeneity was low among the included 
      trials. Exclusion sensitivity and per-protocol analysis demonstrated results 
      consistent with ITT analysis. None of the included studies reported serious 
      adverse events related to EBCR, which supports the safety of EBCR after LVAD 
      implantation. CONCLUSION: This systematic review and meta-analysis demonstrated 
      that EBCR following LVAD implantation is associated with greater improvement in 
      functional capacity compared with ST as reflected by improved peak (Equation is 
      included in full-text article.)O2 and 6MWD. However, given the small number of 
      patients, further research into the clinical impact of EBCR in LVAD patients is 
      necessary.
FAU - Mahfood Haddad, Toufik
AU  - Mahfood Haddad T
AD  - Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska.
FAU - Saurav, Alok
AU  - Saurav A
FAU - Smer, Aiman
AU  - Smer A
FAU - Azzouz, Muhammad S
AU  - Azzouz MS
FAU - Akinapelli, Abhilash
AU  - Akinapelli A
FAU - Williams, Mark A
AU  - Williams MA
FAU - Alla, Venkata M
AU  - Alla VM
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - J Cardiopulm Rehabil Prev
JT  - Journal of cardiopulmonary rehabilitation and prevention
JID - 101291247
SB  - IM
MH  - Cardiac Rehabilitation/*methods
MH  - Exercise Therapy/*methods
MH  - Female
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Male
MH  - Middle Aged
EDAT- 2017/07/21 06:00
MHDA- 2018/07/17 06:00
CRDT- 2017/07/21 06:00
PHST- 2017/07/21 06:00 [pubmed]
PHST- 2018/07/17 06:00 [medline]
PHST- 2017/07/21 06:00 [entrez]
AID - 10.1097/HCR.0000000000000254 [doi]
PST - ppublish
SO  - J Cardiopulm Rehabil Prev. 2017 Nov;37(6):390-396. doi: 
      10.1097/HCR.0000000000000254.