Mediators of the effect of Exercise-Based Cardiac Rehabilitation on Hospitalisation risk in People with Coronary Heart Disease – the CaReMATCH individual participant data meta-analysis

Buckley, B ORCID: 0000-0002-1479-8872 Mediators of the effect of Exercise-Based Cardiac Rehabilitation on Hospitalisation risk in People with Coronary Heart Disease – the CaReMATCH individual participant data meta-analysis. European Journal of Epidemiology (EJE). ISSN 0393-2990 (Accepted)

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Abstract

BACKGROUND. Participation in exercise-based cardiac rehabilitation (ExCR) lowers hospitalisation risk in people with coronary heart disease. We investigated whether improvements in health-related quality of life (HRQoL), including physical and mental dimensions, mediated the effect of ExCR on hospitalisation risk in people with coronary heart disease. METHODS. Individual participant data from five randomised controlled trials were pooled, which randomized participants to ExCR or usual care. All trials had to be published since 2010 to reflect contemporary medicine. A one-stage meta-analysis was performed to assess whether changes in HRQoL, including physical and mental dimensions, mediated the effect of ExCR on all-cause and cardiovascular disease (CVD)-related hospitalisation risk. HRQoL was assessed before and directly following the intervention period, and preceded hospitalisation assessments at 1- and 2-year follow-up. RESULTS. Compared to controls (n=1,986), ExCR (n=1,973) did not reduce 1-year, but significantly reduced 2-year all-cause (hazard ratio [HR] 0.72, 95% confidence interval [CI]: 0.45,1.14; HR 0.61, 95%CI: 0.43,0.87), respectively) and CVD-related hospitalisation risk (HR 0.58, 95%CI: 0.33,1.03; HR 0.56, 95%CI: 0.37,0.87), respectively). Improvements in HRQoL due to ExCR significantly mediated 2-year reductions in all-cause (mediation-effect -0.0011, 95%CI: -0.0013,-0.0009, mediation 7.4%) and CVD-related hospitalisation risk (mediation-effect: -0.0008, 95%CI: -0.0010,-0.0007, mediation 6.2%). Mediation effects were more pronounced in those with a lower baseline HRQoL. Both physical (mediation: all-cause 5.8%; CVD-related 4.4%) and mental HRQoL-dimensions (mediation: all-cause 3.4%; CVD-related 2.6%) mediated the effect of ExCR. CONCLUSIONS. We found improvements in HRQoL, including physical and mental HRQoL-dimensions, to significantly mediate the lower risk for all-cause and CVD-related hospitalisations following participation in ExCR.

Item Type:	Article
Uncontrolled Keywords:	1117 Public Health and Health Services; Epidemiology; 4202 Epidemiology
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Springer
Date of acceptance:	19 June 2026
Date Deposited:	22 Jun 2026 09:29
Last Modified:	22 Jun 2026 09:29
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28870

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