Review question

Is exercise-based cardiac rehabilitation for people with stable angina helpful in improving their condition?

Background

Stable angina is a form of chronic heart disease associated with ill health and increased death rates. Exercise-based cardiac rehabilitation is a programme that helps people with heart disease gain better health. It usually involves exercising and receiving advice on ways to improve health and takes place at hospitals or within the community or at home. The National Institute for Health and Care Excellence in the United Kingdom does not currently recommend cardiac rehabilitation programmes for people with angina, while European and United States guidelines do. In this review, we look at whether cardiac rehabilitation is helpful to people with stable angina. Specifically we assess whether cardiac rehabilitation is helpful in reducing death rates, the need for surgery, repeated heart attacks, healthcare usage and costs; and improving quality of life, physical fitness levels, and symptoms of angina.

Study characteristics

The evidence is current to 2 October 2017. We included seven studies that randomly allocated a total of 581 participants with stable angina to either receive cardiac rehabilitation or no exercise control. We identified that there are no ongoing randomised studies. The average age of participants ranged from 50 to 66 years. The majority of people recruited were middle-aged men. Most studies were carried out in European countries and one study in India. Cardiac rehabilitation was most commonly delivered in a combined setting of home and centre or hospital. The length of the cardiac rehabilitation programmes ranged from six weeks to one year.

Key results

There is insufficient evidence to assess the impact of exercise-based cardiac rehabilitation on the outcomes that matter most to patients: risks of death, heart attack, or future cardiac operation and quality of life. There may be a small improvement in physical fitness following exercise-based cardiac rehabilitation compared to usual treatment. There was no evidence about returning to work.

Quality of the evidence

Due to the poor reporting, high risk of bias and small number of trials and participants included in this review, our assessment of the quality of the evidence ranged from low to very low across outcomes. For low-quality evidence our confidence in the result is limited, and for very low-quality evidence we have very little confidence in the result.

Conclusions

We need more high-quality studies in more representative populations of people with stable angina. These studies should collect outcomes of relevance to patients and healthcare decision-makers. Then we will be able to better assess the impact of exercise-based cardiac rehabilitation.