Frontiers in cardiovascular medicine · 2026
The impact of cardiac rehabilitation on rehospitalization and mortality rates in heart failure with preserved ejection fraction.
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Liu Fenghong, Wang Qiyao, Han Shanshan, Zhang Manman, Bai Xiaoyu, Wang Cuihua
Аннотация
INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF) is associated with substantial functional limitation and recurrent hospitalization, while effective pharmacological options remain limited. Exercise-based cardiac rehabilitation (CR) has been proposed as a non-pharmacological strategy; however, its effects on clinical and functional outcomes in HFpEF remain incompletely defined.This meta-analysis aimed to systematically assess the impact of exercise-based CR on rehospitalization, mortality, functional capacity, quality of life, and cardiac function in patients with HFpEF.
METHODS: A systematic review was conducted according to PRISMA guidelines, with electronic database searches performed through December 2024.Nineteen randomized controlled trials involving 2,025 participants were included. Meta-analyses were performed using RevMan 5.4, with effect estimates expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).
RESULTS: Exercise-based CR did not significantly reduce all-cause mortality (RR 1.13, 95% CI 0.77-1.66), but was associated with a significantly lower risk of rehospitalization (RR 0.52, 95% CI 0.38-0.72). Significant improvements were observed in functional exercise capacity, including 6-minute walk distance (MD 36.89m) and peak oxygen uptake (VO₂peak; MD 2.14mL/kg/min), as well as physical functioning assessed by the SF-36. Exercise-based CR was also associated with a modest reduction in left atrial volume index, whereas left ventricular ejection fraction remained unchanged. In addition, peak heart rate significantly improved (MD 7.74 bpm, 95% CI 3.68-11.80). Data on blood pressure, lipid profile, glycemic control, and cardiovascular mortality were limited or inconsistently reported, precluding meta-analysis.
CONCLUSION: Exercise-based cardiac rehabilitation improves functional capacity,cardiorespiratory fitness,and physical quality of life in patients with HFpEF and reduces rehospitalization risk, although no mortality benefit was observed.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1069784, PROSPERO CRD420251069784.
METHODS: A systematic review was conducted according to PRISMA guidelines, with electronic database searches performed through December 2024.Nineteen randomized controlled trials involving 2,025 participants were included. Meta-analyses were performed using RevMan 5.4, with effect estimates expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).
RESULTS: Exercise-based CR did not significantly reduce all-cause mortality (RR 1.13, 95% CI 0.77-1.66), but was associated with a significantly lower risk of rehospitalization (RR 0.52, 95% CI 0.38-0.72). Significant improvements were observed in functional exercise capacity, including 6-minute walk distance (MD 36.89m) and peak oxygen uptake (VO₂peak; MD 2.14mL/kg/min), as well as physical functioning assessed by the SF-36. Exercise-based CR was also associated with a modest reduction in left atrial volume index, whereas left ventricular ejection fraction remained unchanged. In addition, peak heart rate significantly improved (MD 7.74 bpm, 95% CI 3.68-11.80). Data on blood pressure, lipid profile, glycemic control, and cardiovascular mortality were limited or inconsistently reported, precluding meta-analysis.
CONCLUSION: Exercise-based cardiac rehabilitation improves functional capacity,cardiorespiratory fitness,and physical quality of life in patients with HFpEF and reduces rehospitalization risk, although no mortality benefit was observed.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1069784, PROSPERO CRD420251069784.