In 4 meta-analyzes, the effect of cardiac rehabilitation based on physical training (PT) on clinical outcomes was studied. All of them showed similar results, since based largely on the same research.
The most recent analysis summarized 48 studies with a total of 8940 included patients, randomized or in cardiac rehabilitation groups, or in routine practice groups. Total mortality and mortality from cardiac causes were lower in the cardiac rehabilitation groups by 20 and 26%, respectively (p <0.05 for both indicators). Repetitive MIs were noted 20% less frequently, but this difference was not statistically significant.
Most of the studies included in this meta-analysis were conducted prior to the development of modern strategies for revascularization, so it is possible that many patients in these early studies showed residual coronary stenosis and inducible ischemia. At present, such patients are usually given PTCA or CSH.
Even with the established positive effect of cardiac rehabilitation on myocardial ischemia, due to the widespread use of myocardial revascularization interventions, there is no certainty that cardiac rehabilitation will show a similar decrease in cardiac mortality. The most recent meta-analysis revealed no differences in studies conducted before and after 1995, therefore, the positive effects of cardiac rehabilitation can be considered legitimate for modern cardiological practice.
There were also no differences between the effect of physical training (PT) and more comprehensive rehabilitation programs, which confirms the role of PT in reducing heart mortality.
The results of meta-analyzes confirm the positive effect of physical training (PT), however, none of the studies had sufficient statistical power to confirm the reduction in cardiovascular mortality after cardiac rehabilitation.
Meta-analyzes are often criticized because of their tendency to focus on positive research results. On the other hand, the inclusion of studies based only on TF in meta-analyzes can lead to an underestimation of the effectiveness of complex cardio-rehabilitation. To address these concerns, two large-scale comprehensive cardiac rehabilitation studies are currently underway.
The study GOSPEL (Global Secondary Prevention Strategies for Limit Events after Myocardial Infarction) included 3241 patients from 78 centers in Italy. All patients after 3 months of the standard rehabilitation program will be randomly assigned to a group of 3-year intensive rehabilitation program and a standard observation group in the district clinic.
In the intensive rehabilitation group, they will conduct physical training (TF), lifestyle counseling and RF, and regular clinical examinations once a month for 6 months and then 2 times a year until the end of the study.
In a study of DANREHAB (Danish Cardiac Rehabilitation) with 770 patients with IHD, HF, or those at high risk of developing IHD, an intensive hospital cardiorehabilitation program is carried out for 6 weeks, followed by outpatient observation for 12 months. The program includes TF, nutritional recommendations, counseling on RF, smoking cessation and clinical examinations. Supposed to recruit 1800 patients. When the results of the study will be presented and whether it will be possible to include such a number of patients in the study is unknown.