Meta-analysis of exercise rehabilitation for HFpEF shows mixed outcomes on mortality and rehospitalization

IntroductionHeart failure with preserved ejection fraction (HFpEF) is associated with substantial functional limitation and recurrent hospitalization, while effective pharmacological options remain limited. Exercise-based cardiac rehabilitation (CR) has been proposed as a non-pharmacological strategy; however, its effects on clinical and functional outcomes in HFpEF remain incompletely defined.This meta-analysis aimed to systematically assess the impact of exercise-based CR on rehospitalization, mortality, functional capacity, quality of life, and cardiac function in patients with HFpEF.MethodsA systematic review was conducted according to PRISMA guidelines, with electronic database searches performed through December 2024.Nineteen randomized controlled trials involving 2,025 participants were included. Meta-analyses were performed using RevMan 5.4, with effect estimates expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).ResultsExercise-based CR did not significantly reduce all-cause mortality (RR 1.13, 95% CI 0.77–1.66), but was associated with a significantly lower risk of rehospitalization (RR 0.52, 95% CI 0.38–0.72). Significant improvements were observed in functional exercise capacity, including 6-minute walk distance (MD 36.89m) and peak oxygen uptake (VO₂peak; MD 2.14mL/kg/min), as well as physical functioning assessed by the SF-36. Exercise-based CR was also associated with a modest reduction in left atrial volume index, whereas left ventricular ejection fraction remained unchanged. In addition, peak heart rate significantly improved (MD 7.74 bpm, 95% CI 3.68–11.80). Data on blood pressure, lipid profile, glycemic control, and cardiovascular mortality were limited or inconsistently reported, precluding meta-analysis.ConclusionExercise-based cardiac rehabilitation improves functional capacity,cardiorespiratory fitness,and physical quality of life in patients with HFpEF and reduces rehospitalization risk, although no mortality benefit was observed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1069784, PROSPERO CRD420251069784.