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<p>Participation in exercise-based cardiac rehabilitation (ExCR) lowers hospitalisation risk in people with coronary heart disease. We investigated whether improvements in health-related quality of life (HRQoL), including physical and mental dimensions, mediated the effect of ExCR on hospitalisation risk in people with coronary heart disease. Individual participant data from five randomised controlled trials were pooled, which randomized participants to ExCR or usual care. All trials had to be published since 2010 to reflect contemporary medicine. A one-stage meta-analysis was performed to assess whether changes in HRQoL, including physical and mental dimensions, mediated the effect of ExCR on all-cause and cardiovascular disease (CVD)-related hospitalisation risk. HRQoL was assessed before and directly following the intervention period, and preceded hospitalisation assessments at 1- and 2-year follow-up. Compared to controls (<i>n</i> = 1,986), ExCR (<i>n</i> = 1,973) did not reduce 1-year, but significantly reduced 2-year all-cause (hazard ratio [HR] 0.72, 95% confidence interval [CI]: 0.45,1.14; HR 0.61, 95%CI: 0.43,0.87), respectively) and CVD-related hospitalisation risk (HR 0.58, 95%CI: 0.33,1.03; HR 0.56, 95%CI: 0.37,0.87), respectively). Improvements in HRQoL due to ExCR significantly mediated 2-year reductions in all-cause (mediation-effect − 0.0011, 95%CI: -0.0013,-0.0009, mediation 7.4%) and CVD-related hospitalisation risk (mediation-effect: -0.0008, 95%CI: -0.0010,-0.0007, mediation 6.2%). Mediation effects were more pronounced in those with a lower baseline HRQoL. Both physical (mediation: all-cause 5.8%; CVD-related 4.4%) and mental HRQoL-dimensions (mediation: all-cause 3.4%; CVD-related 2.6%) mediated the effect of ExCR. We found improvements in HRQoL, including physical and mental HRQoL-dimensions, to significantly mediate the lower risk for all-cause and CVD-related hospitalisations following participation in ExCR.</p>

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Mediators of the effect of exercise-based cardiac rehabilitation on hospitalisation risk in people with coronary heart disease – the CaReMATCH individual participant data meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月16日

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  • Iris A. de Koning,
  • Anouk E. Hiensch,
  • Laurien M. Buffart,
  • Benjamin J.R. Buckley,
  • Grace O. Dibben,
  • Dorairaj Prabhakaran,
  • Ambalam M. Chandrasekaran,
  • Sanjay Kinra,
  • Ambuj Roy,
  • Johan A. Snoek,
  • Núria Santaularia,
  • Scott A. Lear,
  • Elisabetta Tonet,
  • Arto J. Hautala,
  • Ralph Maddison,
  • Gregory Y. H. Lip,
  • Tom Vromen,
  • Niels van Royen,
  • Robert Jan M. van Geuns,
  • Hareld M. C. Kemps,
  • Rod S. Taylor,
  • Dick H. J. Thijssen,
  • Niels A. Stens,
  • Alun D. Hughes,
  • Ajay S. Vamadevan,
  • Andrea Raisi,
  • Anil R. Jain,
  • Arnoud W. J. van’t Hof,
  • Bhaskara Rao,
  • Bishav Mohan,
  • Davinder S. Chadha,
  • Dimple Kondal,
  • Divya Soni,
  • Ed P. de Kluiver,
  • Gianluca Campo,
  • Gianni Mazzoni,
  • Giovanni Grazzi,
  • Ian Roberts,
  • Jabir Abdullakutty,
  • Julie Houle,
  • Kalpana Singh,
  • Kaushik Chattopadhyay,
  • Kavita Singh,
  • Kolli S. Reddy,
  • Kushal Madan,
  • Manjunath C. Nanjappa,
  • Nagamalesh U. Madappa,
  • Nagraj Desai,
  • Narsimhan Calambur,
  • Subramaniam Natarajan,
  • K U. Natrajan,
  • Nikhil Tandon,
  • Nishi Chathurvedi,
  • Paul Poirier,
  • Poppy Malinson,
  • Prabhavathi Bhatz,
  • Pradeep A. Praveen,
  • Prakash C. Negi,
  • M R. Prasad,
  • Raghava Sarma,
  • Raji Devarajan,
  • Ravindra K. Tongia,
  • Rita Pavasini,
  • Sadananda S. Kanchanahalli,
  • Satish Patil,
  • Shah Ebrahim,
  • Shankar Patil,
  • Sharad Chandra,
  • Srikumar Swaminathan,
  • Srinivas Mallya,
  • Stefano Volpato,
  • Stuart Pocock,
  • Subhash C. Manchanda,
  • Sudhir R. Naik,
  • Sunil Kumar

摘要

Participation in exercise-based cardiac rehabilitation (ExCR) lowers hospitalisation risk in people with coronary heart disease. We investigated whether improvements in health-related quality of life (HRQoL), including physical and mental dimensions, mediated the effect of ExCR on hospitalisation risk in people with coronary heart disease. Individual participant data from five randomised controlled trials were pooled, which randomized participants to ExCR or usual care. All trials had to be published since 2010 to reflect contemporary medicine. A one-stage meta-analysis was performed to assess whether changes in HRQoL, including physical and mental dimensions, mediated the effect of ExCR on all-cause and cardiovascular disease (CVD)-related hospitalisation risk. HRQoL was assessed before and directly following the intervention period, and preceded hospitalisation assessments at 1- and 2-year follow-up. Compared to controls (n = 1,986), ExCR (n = 1,973) did not reduce 1-year, but significantly reduced 2-year all-cause (hazard ratio [HR] 0.72, 95% confidence interval [CI]: 0.45,1.14; HR 0.61, 95%CI: 0.43,0.87), respectively) and CVD-related hospitalisation risk (HR 0.58, 95%CI: 0.33,1.03; HR 0.56, 95%CI: 0.37,0.87), respectively). Improvements in HRQoL due to ExCR significantly mediated 2-year reductions in all-cause (mediation-effect − 0.0011, 95%CI: -0.0013,-0.0009, mediation 7.4%) and CVD-related hospitalisation risk (mediation-effect: -0.0008, 95%CI: -0.0010,-0.0007, mediation 6.2%). Mediation effects were more pronounced in those with a lower baseline HRQoL. Both physical (mediation: all-cause 5.8%; CVD-related 4.4%) and mental HRQoL-dimensions (mediation: all-cause 3.4%; CVD-related 2.6%) mediated the effect of ExCR. We found improvements in HRQoL, including physical and mental HRQoL-dimensions, to significantly mediate the lower risk for all-cause and CVD-related hospitalisations following participation in ExCR.