Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)

Abstract

Objective: To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction.

Design: Collaborative meta-analysis. Inclusion criteria Randomised parallel group controlled trials of exercise training for at least eight weeks with individual patient data on survival for at least three months. Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls.

Main outcome measure: Death from all causes.

Results: During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank chi(2) = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank chi(2) = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed.

Conclusion: Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target.

Fig 1

Selection process for studies included in meta-analysis

Fig 2

Funnel plot for detection of publication bias

Fig 3

Kaplan-Meier cumulative two year survival (top) and Kaplan-Meier cumulative two year survival or free from admission to hospital (bottom)

Fig 4

Effect of exercise training on death

Fig 5

Effect of exercise training on death or admission to hospital