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Cardiac Rehabilitation in Patients With Left Ventricular Assist Device: A SYSTEMATIC REVIEW AND META-ANALYSIS

Mahfood Haddad, Toufik MD; Saurav, Alok MD; Smer, Aiman MBBCh; Azzouz, Muhammad S. MD; Akinapelli, Abhilash MBBS; Williams, Mark A. PhD; Alla, Venkata M. MD

Journal of Cardiopulmonary Rehabilitation and Prevention: November 2017 - Volume 37 - Issue 6 - p 390–396
doi: 10.1097/HCR.0000000000000254
Scientific Review

Purpose: Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to improve functional capacity in heart failure (HF). However, there are limited data on the effect of EBCR in patients with advanced HF and left ventricular assist devices (LVADs). This meta-analysis sought to evaluate the effects of EBCR on functional capacity in patients with LVAD.

Methods: PubMed, Web of Science, CINAHL, and Cochrane Library databases were searched for randomized studies assessing the impact of EBCR in patients following LVAD implantation compared with standard therapy (ST). Using pre-defined criteria, appropriate studies were identified and selected. Data from selected studies were extracted in a standardized fashion and a meta-analysis was performed using a random-effects model with DerSimonian Liard weighting. Analysis employed weighted mean difference (WMD) as the effect size and intention-to-treat (ITT) principle. Study quality, publication bias, and heterogeneity were assessed.

Results: Six trials with a total of 183 patients (EBCR: 125; ST: 58) were identified. Mean age was 51 years and 83% were males. The initiation of EBCR varied from LVAD implantation during the index hospitalization to 10 mo post-LVAD implantation. The median rehabilitation period ranged from 6 to 10 wk. Exercise-based cardiac rehabilitation was associated with improved peak oxygen uptake (

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O2) in all trials. Quantitative analysis was performed on 3 randomized studies involving 61 patients (EBCR = 39, ST = 22). Exercise-based cardiac rehabilitation was associated with significantly greater peak

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O2 (WMD: 3.00 mL/kg/min; 95% CI: 0.64-5.35, P = .001). Similarly, 6-minute walk distance (6MWD) showed significantly greater improvement in the EBCR group than in the ST group (WMD: 60.06 m; 95% CI, 22.61-97.50, P = .002). Heterogeneity was low among the included trials. Exclusion sensitivity and per-protocol analysis demonstrated results consistent with ITT analysis. None of the included studies reported serious adverse events related to EBCR, which supports the safety of EBCR after LVAD implantation.

Conclusion: This systematic review and meta-analysis demonstrated that EBCR following LVAD implantation is associated with greater improvement in functional capacity compared with ST as reflected by improved peak

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O2 and 6MWD. However, given the small number of patients, further research into the clinical impact of EBCR in LVAD patients is necessary.

Supplemental Digital Content is Available in the Text.Systematic review and meta-analysis were performed evaluating the impact of exercise-based cardiac rehabilitation (EBCR) on left ventricular assist device recipients. Using data from 3 randomized controlled trials, EBCR is associated with greater improvement in functional capacity compared with standard therapy, reflected by improved peak oxygen uptake and 6-minute walk distance.

Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska.

Correspondence: Toufik Mahfood Haddad, MD, Division of Cardiology, 3006 Webster St, Omaha, NE 68131 (Toufikmahfoodhaddad@creighton.edu).

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's website (www.jcrpjournal.com).

The authors declare no conflicts of interest.

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