A substantive amendment to this sys...

A substantive amendment to this systematic review was last made upon 22 November 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: The tonnage of cardiovascular disease worldwide is single of great concern to patients and health care agencies alike. Cardiac rehabilitation aims to restore patients with heart disease to health between the sides of exercise only based rehabilitation or comprehensive cardiac rehabilitation.

Objectives: To determine the effectiveness of exercise and nothing else or exercise as part of a comprehensive cardiac rehabilitation programme forward the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease.

Search strategy: Electronic databases were searched for randomised controll trials, using standardised trial filters, from the earliest date available to December 31 st 1998

Selection criteria: Men and women of all ages, in hospital or community settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined from angiography.

Data collection and analysis: Studies were pitch uponed independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information.

Main results: This systematic review has allowed analysis of an increased number of patients from approximately 4500 in earlier meta-analyses to 8440 (7683 contributing to the total mortality outcome)

The plashed effect estimate for total mortality for the exercise barely intervention shows a 27% reduction in all cause mortality (random purports model OR 0.73 (0.54, 098)) Comprehensive cardiac rehabilitation reduc all cause mortality, yet to a lesser degree (OR 087 (071 105)) Total cardiac mortality was reduc by the agency of 31 % (random effects pattern OR 0.69 (0.51, 0.94)) and 26% (random purports model OR 0.74 (0.57, 096)) in the exercise solely and comprehensive cardiac rehabilitation arranges respectively. Neither intervention had any import on the ocurrence of non-fatal myocardial infarction.

There was a significant pure reduction in total cholesterol (pool WMD random drifts model -0.57 mmol/I (-0.83, -- 031)) and LDL (pool WMD random purports model -0.51 mmol/l (-0.82, -019) in the comprehensive cardiac rehabilitation assemblage

Reviewers' conclusions: Exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise barely or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominately male, middle aged and soft risk. Identification of the ethnic origin of the participants was seldom reported. It is possible that patients who would have benefited most numerous from the intervention were exclud from the trials in succession the grounds of age, sex or co-morbidity.

Background

The cargo of cardiovascular disease (CVD) world-wide is united of great concern to patients and health care agencies alike. Circulatory diseases, including myocardial infarction (MI) and rap kill more people than any other disease. This accounts for 15 million deaths, 30% of the annual total, each year (WHO 1997). In the USA more than 135 million Americans have a history of MI, or experience angina pectoris (Wenger 1995) In Australia in 1994 cardiovascular disease (the largest ingredient of which is coronary heart disease (CHD)) was certified as the primary cause in 4333% of all deaths in Australia (Goble & Worcester 99) Eastern Europe is now experiencing an increasing number of deaths from CVD across all socioeconomic collections death rates exceeding those in Western Europe the USA, Australia and of the present day Zealand (WHO 1994). Asia too is suffering an increasing prevalence of CVD particularly among the growing professional, managerial, business and factory supervising assign places tos Janus 1996).

CHD is the single leading cause of death for the couple men and women in the UK accounting for 238 deaths for 100,000 population in 1997 (approximately 140000 people) (ONE 1999) Scotland, Northern Ireland and England and Wales rank 3rd 5th and 9th in the top ten of 30 chooseed Organisation for Economic Cooperation and growth (OECD) countries with CHD rates (in men and women aged 45-64) any four or five times those of the countries at the bottom of the list (OHE 1999) Diseases of the circulatory arrangement accounted for 108.2 million days of certified incapacity in men and women in 1996/ 97 12% of the total (ONE 1999) In the older age cluster (over 65) one fifth of men and the same eighth of women in England and Wales were treated for CHD in General Practice in 1996 (ON 1999) These observations are likely to shut in true for the population of other discloseed countries. Cardiac rehabilitation services have been defined as: "comprehensive, long-term programmes involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counselling for patients who have undergoed a myocardial infarction (MI), undergone cardiac surgery or bear up under from heart failure or angina pectoris" (Wenger 1995) Goble & Worcester (Goble & Worcester 99) have taken previous definitions through the World Health Organisation (WHO), the United States Public Health Service and the Cardiac Rehabilitation Working arrange of the European Society of Cardiology and give a broader definition of cardiac rehabilitation; "Cardiac rehabilitation is the coordinated totality of interventions required to make secure the best physical, psychological and social conditions with equal reason that patients with chronic or post-acute cardiovascular disease may, from their own efforts, preserve or take back optimal functioning in society and, in consequence of improved health behaviours, slow or turn topsy-turvy progression of disease." Current provision of cardiac rehabilitation in the UK varies widely in practice and organisation (Davidson 1995) There is evidence that national guidelines for cardiac rehabilitation (Thompson 1996) and secondary prevention measures (ASPIRE 1996 Campbell 1998) are subordinate to applied (NHS 1998, Stokes 1998) The National Service Framework for CHD (Department of Health DOH 2000) has been published to address a certain of these issues.