Evidence map›Paper›PMID 27777324›Full record

SynthesisEuropean journal of preventive cardiology2016

The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS).

Bernhard Rauch, Constantinos H Davos, Patrick Doherty, Daniel Saure, Maria-Inti Metzendorf, Annett Salzwedel, Heinz Völler, Katrin Jensen, Jean-Paul Schmid, ‘Cardiac Rehabilitation Section’, European Association of Preventive Cardiology (EAPC), in cooperation with the Institute of Medical Biometry and Informatics (IMBI), Department of Medical Biometry, University of Heidelberg, and the Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Heinrich-Heine University, Düsseldorf, Germany

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European journal of preventive cardiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06919237 (Chronic Adaptations in Cardiovagal Modulation and Cardiorespiratory Fitness in Patients With Coronary Artery Disease to a 12-week Heart Rate Variability-guided Training vs Traditional Aerobic Prescription Program), which is not on this map. Cited by 106 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
106citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06919237 nanot yet recruitingnot on this mapstarted 2025, after this paper: background citation

Chronic Adaptations in Cardiovagal Modulation and Cardiorespiratory Fitness in Patients With Coronary Artery Disease to a 12-week Heart Rate Variability-guided Training vs Traditional Aerobic Prescription Program: Study Protocol for a Randomized Controlled Trial

TypeinterventionalSponsorFaculdade de Motricidade HumanaRan2025 to 2028Enrolled48ConditionsCoronary Arterial Disease (CAD)ArmsHIIT Intervention, MICT Intervention, HRV-Guided Intervention
3 · Its place in the literature

Who cites it

106 citing papers in PubMed, 9 syntheses or guidelines pooled it.

  1. Pooled it
  2. Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review.International journal of environmental research and public health · 2023
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Exercise-based cardiac rehabilitation for coronary heart disease.The Cochrane database of systematic reviews · 2021
    Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Trial
  11. Trial
  12. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Trial
  13. Trial
  14. Article
  15. Article
  16. Review
  17. Article
  18. Exercise Prescription in Cardio-Oncology.Journal of clinical medicine · 2025
    Review
  19. Review
  20. Article

46 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Bernhard Rauch1 Institut für Herzinfarktforschung Ludwigshafen, Germany.
Constantinos H Davos2 Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece.
Patrick Doherty3 Department of Health Sciences, University of York, UK.
Daniel Saure4 Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany.
Maria-Inti Metzendorf5 Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, University of Düsseldorf, Germany.
Annett Salzwedel6 Centre of Rehabilitation Research, University of Potsdam, Germany.
Heinz Völler6 Centre of Rehabilitation Research, University of Potsdam, Germany.
Katrin Jensen4 Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany.
Jean-Paul Schmid7 Department of Cardiology Spital Tiefenau, Switzerland.
‘Cardiac Rehabilitation Section’, European Association of Preventive Cardiology (EAPC), in cooperation with the Institute of Medical Biometry and Informatics (IMBI), Department of Medical Biometry, University of Heidelberg, and the Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Heinrich-Heine University, Düsseldorf, Germany

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n = 18,534 abstracts, 25 studies were identified for final evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702 patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.

Indexed as

Myocardial IschemiaCardiac RehabilitationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMyocardial RevascularizationPrognosisTreatment OutcomeHydroxymethylglutaryl-CoA Reductase Inhibitorsacute coronary syndromecoronary artery diseasecoronary bypass graftinghospital readmissionmortalityRehabilitation

Identifiers

PMID27777324
PMCPMC5119625

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.