Non-Pharmacological Interventions in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Network Meta-Analysis

Yilun Li; Wenbo He; Jingwen Jiang; Jiawen Zhang; Mingfeng Ding; Gaiyun Li; Xiaolei Luo; Ziyuan Ma; Jingyi Li; Yichen Ma; Yanfei Shen; Xuemei Han

doi:10.1016/j.apmr.2023.07.004

Non-Pharmacological Interventions in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Network Meta-Analysis

Arch Phys Med Rehabil. 2023 Jul 25:S0003-9993(23)00410-0. doi: 10.1016/j.apmr.2023.07.004. Online ahead of print.

Authors

Yilun Li¹, Wenbo He², Jingwen Jiang¹, Jiawen Zhang¹, Mingfeng Ding¹, Gaiyun Li¹, Xiaolei Luo¹, Ziyuan Ma¹, Jingyi Li¹, Yichen Ma¹, Yanfei Shen³, Xuemei Han⁴

Affiliations

¹ School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
² Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
³ Office of Legal Affairs, Gansu Provincial Hospital, Lanzhou, Gansu, China.
⁴ School of Public Health, Lanzhou University, Lanzhou, Gansu, China. Electronic address: xmhan@lzu.edu.cn.

PMID: 37499852
DOI: 10.1016/j.apmr.2023.07.004

Abstract

Objective: To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection fraction (HFrEF).

Data sources: We searched PubMed, Embase, and the Cochrane Clinical Trials Register from the date of database inception to April 22, 2023.

Study selection: Randomized controlled trials involving non-pharmacologic interventions conducted in patients with HFrEF were included.

Data extraction: Data were extracted by 2 independent reviewers based on a pre-tested data extraction form. The quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation method.

Data synthesis: A total of 82 eligible studies (4574 participants) were included. We performed a random-effects model within a Bayesian framework to calculate weighted mean differences (WMDs) and 95% credibility intervals. High or moderate certainty evidence indicated that high-intensity aerobic interval training (HIAIT) was best on improving 6-minute walk distance (6MWD; 68.55 m [36.41, 100.47]) and left ventricular ejection fraction (6.28% [3.88, 8.77]), while high-intensity aerobic continuous training (HIACT) is best on improving peak oxygen consumption (Peak VO₂; 3.48 mL/kg•min [2.84, 4.12]), quality of life (QOL; -17.26 [-29.99, -7.80]), resting heart rate (-8.20 bpm [-13.32, -3.05]), and N-terminal pro-B-type natriuretic peptide (-600.96 pg/mL [-902.93, -404.52]). Moderate certainty evidence supported the effectiveness of inspiratory muscle training to improve peak oxygen consumption and functional electrical stimulation to improve QOL. Moderate-intensity aerobic continuous training (MIACT) plus moderate-intensity resistance training (MIRT) had additional benefits in Peak VO₂, 6MWD, and QOL. This review did not provide a comprehensive evaluation of adverse events.

Conclusions: Both HIAIT and HIACT are the most effective single non-pharmacologic interventions for HFrEF. MIACT plus MIRT had additional benefits in improving peak oxygen consumption, 6MWD, and QOL.

Keywords: Heart failure; Network meta-analysis; Non-pharmacologic interventions; Rehabilitation; Systematic review.

Publication types

Review