Gadager, Birgitte Bitsch, Tang, Lars Hermann, Ravn, Maiken Bay et al. (6 more authors) (2022) Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes:a systematic review and meta-analysis. BMC Cardiovascular Disorders. 295. ISSN 1471-2261
Abstract
AIM: The benefits of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) are well established. However, the relative benefit of CR in those with comorbidities, including diabetes, is not well understood. This systematic review and meta-analysis examined the benefit of CR on exercise capacity and secondary outcomes in ACS patients with a co-diagnosis of diabetes compared to those without. METHODS: Five databases were searched in May 2021 for randomised controlled trials (RCTs) and observational studies reporting CR outcomes in ACS patients with and without diabetes. The primary outcome of this study was exercise capacity expressed as metabolic equivalents (METs) at the end of CR and ≥ 12-month follow-up. Secondary outcomes included health-related quality of life, cardiovascular- and diabetes-related outcomes, lifestyle-related outcomes, psychological wellbeing, and return to work. If relevant/possible, studies were pooled using random-effects meta-analysis. RESULTS: A total of 28 studies were included, of which 20 reported exercise capacity and 18 reported secondary outcomes. Overall, the studies were judged to have a high risk of bias. Meta-analysis of exercise capacity was undertaken based on 18 studies (no RCTs) including 15,288 patients, of whom 3369 had diabetes. This analysis showed a statistically significant smaller difference in the change in METs in ACS patients with diabetes (standardised mean difference (SMD) from baseline to end of CR: - 0.15 (95% CI: - 0.24 to - 0.06); SMD at the ≥ 12-month follow-up: - 0.16 (95% CI: - 0.23 to - 0.10, four studies)). CONCLUSION: The benefit of CR on exercise capacity in ACS patients was lower in those with diabetes than in those without diabetes. Given the small magnitude of this difference and the substantial heterogeneity in the results of the study caused by diverse study designs and methodologies, further research is needed to confirm our findings. Future work should seek to eliminate bias in observational studies and evaluate CR based on comprehensive outcomes.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022. The Author(s). |
Keywords: | Acute Coronary Syndrome/diagnosis,Cardiac Rehabilitation/methods,Diabetes Mellitus/diagnosis,Exercise Therapy/methods,Humans,Quality of Life |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) |
Depositing User: | Pure (York) |
Date Deposited: | 18 Jul 2022 12:30 |
Last Modified: | 21 Jan 2025 18:03 |
Published Version: | https://doi.org/10.1186/s12872-022-02723-5 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1186/s12872-022-02723-5 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:189213 |