The Effects of Cardiac Rehabilitation in Patients With Atrial Fibrillation: A Systematic Review

Background: Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity and mortality. Clinical guidelines for managing patients with AF do not include a referral to cardiac rehabilitation (CR) at present, although it is routine for most other cardiovascular conditions. The number of studies evaluating the impact of CR on the health of patients with AF is growing, but there has been no consolidation of the findings. The objective of this systematic review was to evaluate the impact of CR programs on physical and mental health outcomes in patients with all forms of AF. Methods: Six electronic databases were searched to identify all studies that reported on the impact of CR in patients with AF. Searching identified 5771 potential articles, of which 12 were included. The physical health outcomes evaluated included cardiometabolic health indicators, aerobic and functional capacity, severity of symptoms, recurrence of AF, hospitalizations, and mortality. The mental health outcomes assessed included quality of life, anxiety, depression, and quality of sleep. Results: The limited evidence supports the use of CR to improve cardiometabolic health indicators and aerobic and functional capacity in patients with AF. The current evidence suggests that prominent improvements in aerobic fitness are associated with lower risk of hospitalization and mortality. The conflicting mental health findings may be due to the varying severity of AF and or modes of exercise interventions. Conclusions: Gaps in the research identified the need for greater rigor in the reporting of intervention details, outcomes, and statistical methodology; sex-and gender-based analyses; and effectiveness trials. This review serves as a call to action for more work globally on this important area.