Cardiac rehabilitation, July 2018

Cardiac Rehabilitation Priority Exercise of Review Updates

Aim

The aim of this priority exercise was to help guide the Cochrane Heart Group in the prioritisation of the cardiac rehabilitation systematic review titles that are due an update or as potential new titles.

Survey

An online survey of multiple choice questions was set up using Survey Monkey. The questions were composed of review titles from the cardiac rehabilitation portfolio, which require a decision on update and some new potential titles. Respondents were asked to select whether they considered the topic to be high priority, medium priority, low priority or ‘don’t know’.

The topics included:

Q1. Exercise-based cardiac rehabilitation in heart transplant recipients
Q2. Exercise-based cardiac rehabilitation for adults with atrial fibrillation
Q3. Exercise-based cardiac rehabilitation for coronary heart disease
Q4. Exercise-based cardiac rehabilitation for adults after heart valve surgery
Q5. Promoting patient uptake and adherence in cardiac rehabilitation
Q6. Exercise-based cardiac rehabilitation for patients following open surgical aortic valve replacement
Q7. Exercise-based cardiac rehabilitation for patients with Transcatheter Aortic Valve Implant (TAVI)

Followed by the open ended question:

Q8. Are there any other titles you would like to suggest?

Dissemination

The link to the survey was disseminated to researchers and health care professionals in cardiac rehabilitation. We contacted the following groups requesting they completed the survey and for further dissemination.

  • British Association for Cardiovascular Prevention and Rehabilitation
  • The ESC CR working group
  • The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
  • Asian Pacific Society of Cardiology
  • Irish Association of Cardiac Rehabilitation

As well as corresponding authors from recent publications in the European Journal of Preventive Cardiology.

Output

We received 177 responses to the questionnaire.

The two review titles with the highest percentage of respondents selecting high priority were Question 5: Promoting patient uptake and adherence in cardiac rehabilitation (85.23%) and Question 3: Exercise-based cardiac rehabilitation for coronary heart disease (74.01%). Please see graph 1.

Graph 1:

The review title with the third highest percentage was Q4: ­­ Exercise-based cardiac rehabilitation for adults after heart valve surgery (51.70%). This remained the third highest priority when medium priority responses were added to the totals (Graph 2).

Graph 2:

Question 8 on the survey was a free text question asking for other titles the respondents would like to suggest. 65 responded to this question with suggestions totalling 103. Similar answers were grouped together providing the following data.

Suggested Review Category
Number Suggested
CR in Heart Failure
18
CR following device implantation
18
CR for other CVD outcomes
16
CR program issues
10
CR new exercise methods
8
CR in Heart Failure patients with PEF
7
CR with other morbidities
7
CR following surgery
7
Congenital Heart Disease - Adults
5
CR other than exercise
5
Congenital Heart Disease - All
2

Conclusions

Following the priority exercise the suggestions are:

  1. Promoting CR uptake – first/main priority (will actually be published in the next few days)
  2. Cardiac rehabilitation post-myocardial infarction - for priority new title
  3. Post-TAVI - priority for new title
  4. Adults after Heart Valve Surgery – for priority update;
  5. Cardiac Rehabilitation in patients with heart failure – for update (or if enough trials are available I suggest splitting into 2: HF with reduced EF and HF with preserved EF)

Further work could involve a similar open ended question to patients offered and undergoing cardiac rehabilitation. This compared with the results of the open question in this exercise could help to inform future review titles. 

Further Conclusions

Titles suggested to people filling in the survey:

Q1 – Heart Transplant – only 48.02% high priority; not for an update yet, but reassess in 2 years – published in April 2017 (searches until June 2016)
Q2 – Atrial fibrillation – only 43.18%; not for an update yet, but reassess in 2 years – published February 2017 (searches until July 2016)
Q3 – for coronary artery disease titles (Stable angina was recently published so, it will not be a priority for the next 2 years; coronary artery disease review published in January 2016;) –  suggest new title – cardiac rehabilitation post-myocardial infarction for priority new title (if not being done already)
Q4 – Adults after Heart Valve Surgery – 51.70% (3rd title); published in March 2016 (searches until March 2015); Therefore, for priority update;
Q5 – Promoting CR uptake – 85.23% considered it a priority – should be the first/main priority
Q6 – open surgical aortic valve replacement  - among the 2 least voted entries; Therefore, not for new title; I think we can do the update on post-heart valve surgery including all open heart valve surgery procedures combined (Q4);
Q7 – post-TAVI 45.76% - second most voted new title (45.76% considered it high priority and if we add medium priority it goes up to 82.48% – therefore, priority for new title)

Suggestions of titles by people filling in the survey (Q8):

  • 18 people suggested heart failure (> 10% of respondents) Update for the Heart Failure Review – published in April 2014, searches
  • If we have enough studies focusing on hard endpoints including patients with preserved LVEF, I suggest we do a new review with this title as 7 people mentioned this would be a priority).
  • 18 people suggested CR following device implantation; we recently had reviews on ICDs and LVADs published in the group. Should potential authors scope publications regarding CR in CRTs and pacemakers to see if there are enough trials?