European journal of epidemiology · 2026
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.
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de Koning Iris A, Hiensch Anouk E, Buffart Laurien M, Buckley Benjamin J R, Dibben Grace O, Prabhakaran Dorairaj, Chandrasekaran Ambalam M, Kinra Sanjay, Roy Ambuj, Snoek Johan A, Santaularia Núria, Lear Scott A, Tonet Elisabetta, Hautala Arto J, Maddison Ralph, Lip Gregory Y H, Vromen Tom, van Royen Niels, van Geuns Robert Jan M, Kemps Hareld M C, Taylor Rod S, Thijssen Dick H J, Stens Niels A, CaReMATCH collaborators
Аннотация
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.