심부전 또는 급성 심근경색 환자에서 심장 재활의 효과에 대한 체계적 문헌고찰 및 메타분석

Abstract

Objectives: This study systematically reviewed and meta-analyzed randomized controlled trials (RCTs) to evaluate the effects of cardiac rehabilitation (CR) programs on patients with heart failure (HF) or acute myocardial infarction (AMI). The assessment focuses on studies published after 2000, reflecting recent advancements in medical technologies and clinical guidelines. Methods: Systematic searches were conducted in Ovid MEDLINE, Cochrane Library, KMbase, and KoreaMed for articles published since 2018. Additionally, literature from 2000 to 2018, included in 2 Cochrane reviews, was manually screened and incorporated to ensure a comprehensive review of studies published from 2000 onward. Two independent reviewers selected RCTs based on PICO-TS criteria. In the final se lection process, only studies that were published after the year 2000 were included. Data extraction covered study design, intervention characteristics, and outcomes, including mortality, and readmis sion rates. The risk of bias was assessed using the Cochrane tool, and evidence certainty was evaluat ed by the GRADE methodology. Meta-analyses were conducted using random-effects models to esti mate the average treatment effects across studies. Results: A total of 22 RCTs were included (14 for HF and 8 for AMI). In HF patients, CR significantly reduced all-cause readmission (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.57–0.90) and cardiovascular-related readmission (RR 0.61, 95% CI 0.40–0.93), although reductions in all-cause mortality and cardiovascular-related mortality were not statistically significant. In AMI patients, CR significantly reduced cardiovascular-related mortali ty (RR 0.49, 95% CI 0.26–0.90), while effects on other outcomes were inconclusive. Evidence certain ty varied from moderate to low due to study heterogeneity. Conclusion: CR programs demonstrate meaningful clinical benefits, particularly in reducing readmission for HF and cardiovascular-related mortality for AMI. Although this study acknowledged some limitations, including heterogeneity among studies and small sample sizes, these findings reinforce the importance of expanding CR pro grams as key strategies for secondary prevention in cardiovascular care.