Abstract 11878: Physiologic Changes Induced by Cardiac Rehabilitation in Post Myocardial Infarction Patients: A Systematic Review and Meta-analysis

Abstract

Introduction: A meta-analysis to evaluate the physiologic changes associated with Cardiac Rehabilitation (CR) in post myocardial infarction (MI) patients was conducted. Hypothesis: CR is a non-pharmacological intervention associated with improved outcomes after MI Methods: We performed an online database search of PubMed, MEDLINE, EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR (1988 - Present); and reviewed key bibliographies. Studies comparing post MI patients according to CR referral were included. Relative risks with the corresponding 95% confidence intervals (CI) by random effects models of pooled data were calculated. Study quality was assessed using STROBE criteria. Outcomes of interest measured after conclusion of CR, these included resting and maximum heart rate (HR), Peak VO2, ejection fraction (EF), wall motion score index (WMSI), left ventricular end diastolic diameter (LVEDD) Results: Of 147 studies searched, 23 studies met our selection criteria, 19 of which were randomized clinical trials, including 1683 patients (827 referred to CR vs 855 not enrolled in CR). Median age was 58 years. There were no significant difference between the two groups in terms of age, comorbidities, severity, baseline EF or HR. CR patients had significantly lower post-exercise resting HR (RR:-0.72, CI:-0.87 to -0.56; p<0.05), higher EF (RR:0.14, CI:0.04-0.25, p<0.05), lower LVEDD (RR: -0.31, CI:-059,-0.02;p <0.05), lower WMSI (RR:-0.33, CI:-0.62, -0.05; p<0.05), and higher peak VO2 (RR:1.00, CI:0.56 - 1.45; p<0.05) Conclusions: This meta-analysis demonstrates that CR is associated with positive physiologic changes post MI. This may explain the reported improvement of functional status and decreased mortality among patients referred to CR. Further randomized trials may help evaluate the long term benefits of CR