Impact of Long-Term Exercise-Based Cardiac Rehabilitation in Patients With Chronic Heart Failure ― A Systematic Review and Meta-Analysis ―

Background: This study aimed to clarify the effects of exercise-based cardiac rehabilitation (CR) on patients with heart failure. Methods and Results: Patients were divided into groups according to intervention duration (<6 and >= 6 months). We searched for studies published up to July 2023 in Embase, MEDLINE, PubMed, and the Cochrane Library, without limitations on data, language, or publication status. We included randomized controlled trials comparing the efficacy of CR and usual care on mortality, prehospitalization, peak oxygen uptake (VO2), and quality of life. Seventy-two studies involving 8,495 patients were included in this review. It was found that CR reduced the risk of rehospitalization for any cause (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.70-0.92) and for heart failure (RR 0.88; 95% CI 0.78-1.00). Furthermore, CR was found to improve exercise tolerance (measured by peak VO(2)and the 6-min walk test) and quality of life. A subanalysis performed based on intervention duration (<6 and >= 6 months) revealed a similar trend. Conclusions: Our meta-analysis showed that although CR does not reduce mortality, it is effective in reducing rehospitalization rates and improving exercise tolerance and quality of life, regardless of the intervention duration.