Ann Rehabil Med.  2021 Feb;45(1):57-70. 10.5535/arm.20080.

Do Cardiac Rehabilitation Affect Clinical Prognoses Such as Recurrence, Readmission, Revascularization, and Mortality After AMI?: Systematic Review and Meta-Analysis

• Kim C
• Choi I
• Cho S
• Kim AR
• Kim W
• Jee S

• KMID: 2513231
• DOI: http://doi.org/10.5535/arm.20080

Abstract

Objective
We conducted a systematic review and meta-analysis to analyze the effects of cardiac rehabilitation (CR) on post-discharge prognoses of patients with acute myocardial infarction (AMI).
Methods
A literature search was conducted through four international medical and two Korean databases. Primary outcomes for the effectiveness of CR included all-cause mortality, cardiovascular mortality, recurrence, revascularization, major adverse cardiovascular event, major adverse cardiocerebrovascular event, and readmission. We summarized and analyzed results of studies about CR for AMI, including not only randomized controlled trials (RCTs) but also non-RCTs. We calculated the effect size separately by the study type.
Results
Fourteen articles were finally selected. Of these, two articles were RCTs, while 12 were non-RCTs. In RCTs, the overall mortality rate was lower in the group that participated in CR than that in the conventional care group by 28% (relative risk=0.72; 95% confidence interval, 0.34–1.57). Among non-RCTs, CR participation significantly decreased the overall risk of mortality. Moreover, the rates of recurrence and major adverse cardiovascular events were lower in the group that participated in CR compared to those in the non-CR group.
Conclusion
The meta-analysis shows that CR reduces the risk of re-hospitalization and all-cause mortality after AMI, compared to no participation in CR. This outcome was seen in RCTs as well as in non-RCTs. More studies are necessary for concrete conclusions about the beneficial effects of CR after AMI in various settings.

Keyword

Myocardial infarction, Cardiac rehabilitation, Recurrence, Readmission, Mortality

Figure

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  Fig. 1. Summary of study selection process.

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  Fig. 2. Summary of risk of bias of the randomized controlled study.

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  Fig. 3. Summary of risk of bias according to the study design. (A) Prospective cohort study. (B) Retrospective cohort study.

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  Fig. 4. Forest plot of all-cause mortality in two randomized controlled trials (RCTs). There was a decreased tendency on all-cause mortality in the cardiac rehabilitation (CR) group.

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  Fig. 5. Forest plot for re-intervention among non-randomized controlled trials (non-RCTs).

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  Fig. 6. Forest plot on recurrence after acute myocardial infarction among non-randomized controlled trials (non-RCTs). Cardiac rehabilitation (CR) group showed a significant decrease in recurrence.

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  Fig. 7. Forest plot on readmission after acute myocardial infarction among non-randomized controlled trials (non-RCTs). CR, cardiac rehabilitation.

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  Fig. 8. Forest plot on major adverse cardiac and cerebrovascular events after acute myocardial infarction

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