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Question 20#

You are working on a cardiology ward in a district general hospital and have been asked to teach the medical students about cardiac rehabilitation. One of the students asks if there is an evidence base to support the role of CR. 

Which one of the following is the correct response?

A) The evidence is anecdotal but patients like it
B) There is a moderate level of evidence with some randomized controlled trials suggesting efficacy
C) There is good evidence for CR in patients with ACS, but the role of CR in chronic heart failure patients is based only on the extrapolation of this data
D) There is a strong evidence base with many randomized controlled trials and meta-analyses supporting clinical and cost effectiveness
E) There is better evidence for PCI in terms of life-years gained

Correct Answer is D


A Cochrane review of exercise training (Jolliffe et al. 2001, updated in 2009) demonstrated that exercise-only cardiac rehabilitation and comprehensive CR reduced all-cause mortality by 27% and 13%, respectively, and cardiac death by 31% and 26%, respectively, for patients with previous MI, revascularization, or angina. There was no effect on non-fatal MI alone and there was no apparent additional benefit from comprehensive CR. The population studied included predominantly younger low-risk male patients. A Cochrane review of studies of exercised-based CR in patients with mild to moderate heart failure (Davies et al. 2010) demonstrated a 28% reduction in heart-failure-related hospital admissions and an improvement in patients’ quality of life, although no significant reduction in all-cause mortality was shown.

Davies EJ, Moxham T, Rees K, et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Failure 2010; 12: 706–15.

Jolliffe J, Rees K, Taylor RRS, Thompson DR, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev, 2001; (1): CD001800.