Cardiac Rehabilitation for Heart Failure: 'Cinderella' or Evidence-based Pillar of Care?

Overview

Journal Eur Heart J

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2023 Mar 11

PMID 36905176

Authors

Rod S Taylor

Hasnain M Dalal

Ann-Dorthe Zwisler

Affiliations

Soon will be listed here.

Abstract

Cardiac rehabilitation remains the 'Cinderella' of treatments for heart failure. This state-of-the-art review provides a contemporary update on the evidence base, clinical guidance, and status of cardiac rehabilitation delivery for patients with heart failure. Given that cardiac rehabilitation participation results in important improvements in patient outcomes, including health-related quality of life, this review argues that an exercise-based rehabilitation is a key pillar of heart failure management alongside drug and medical device provision. To drive future improvements in access and uptake, health services should offer heart failure patients a choice of evidence-based modes of rehabilitation delivery, including home, supported by digital technology, alongside traditional centre-based programmes (or combinations of modes, 'hybrid') and according to stage of disease and patient preference.

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References

Vishwanath V, Beckman A, Kazi D . Reimagining Cardiac Rehabilitation in the Era of Coronavirus Disease 2019. JAMA Health Forum. 2022; 1(11):e201346. DOI: 10.1001/jamahealthforum.2020.1346. View

Brahmbhatt D, Cowie M . Remote Management of Heart Failure: An Overview of Telemonitoring Technologies. Card Fail Rev. 2019; 5(2):86-92. PMC: 6545972. DOI: 10.15420/cfr.2019.5.3. View

Kitagawa T, Hidaka T, Watanabe N, Naka M, Yamaguchi M, Kanai K . Current conditions and significance of outpatient cardiac rehabilitation and home nursing-care services in heart failure patients with mid-range or preserved ejection fraction: post-hoc analysis of the REAL-HF registry. Heart Vessels. 2021; 37(5):745-754. DOI: 10.1007/s00380-021-01965-1. View

Long L, Mordi I, Bridges C, Sagar V, Davies E, Coats A . Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019; 1:CD003331. PMC: 6492482. DOI: 10.1002/14651858.CD003331.pub5. View

Rauch B, Salzwedel A, Bjarnason-Wehrens B, Albus C, Meng K, Schmid J . Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1. J Clin Med. 2021; 10(10). PMC: 8161282. DOI: 10.3390/jcm10102192. View

Timm H, Thuesen J, Clark D . Rehabilitation and palliative care: histories, dialectics and challenges. Wellcome Open Res. 2022; 6:171. PMC: 8790711. DOI: 10.12688/wellcomeopenres.16979.1. View

Adamo M, Gardner R, McDonagh T, Metra M . The 'Ten Commandments' of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 43(6):440-441. DOI: 10.1093/eurheartj/ehab853. View

Laoutaris I, Dritsas A, Adamopoulos S . Cardiovascular rehabilitation in the COVID-19 era: 'a phoenix arising from the ashes?'. Eur J Prev Cardiol. 2021; 29(10):1372-1374. PMC: 8344487. DOI: 10.1093/eurjpc/zwab116. View

Eberly L, Khatana S, Nathan A, Snider C, Julien H, Deleener M . Telemedicine Outpatient Cardiovascular Care During the COVID-19 Pandemic: Bridging or Opening the Digital Divide?. Circulation. 2020; 142(5):510-512. PMC: 9126131. DOI: 10.1161/CIRCULATIONAHA.120.048185. View

10.

Valencia H, Savage P, Ades P . Cardiac rehabilitation participation in underserved populations. Minorities, low socioeconomic, and rural residents. J Cardiopulm Rehabil Prev. 2011; 31(4):203-10. DOI: 10.1097/HCR.0b013e318220a7da. View

11.

Heidenreich P, Bozkurt B, Aguilar D, Allen L, Byun J, Colvin M . 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(18):e895-e1032. DOI: 10.1161/CIR.0000000000001063. View

12.

Taylor R, Walker S, Smart N, Piepoli M, Warren F, Ciani O . Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis. J Am Coll Cardiol. 2019; 73(12):1430-1443. PMC: 8351793. DOI: 10.1016/j.jacc.2018.12.072. View

13.

Pandey A, Segar M, Singh S, Reeves G, OConnor C, Pina I . Frailty Status Modifies the Efficacy of Exercise Training Among Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the HF-ACTION Trial. Circulation. 2022; 146(2):80-90. PMC: 10273304. DOI: 10.1161/CIRCULATIONAHA.122.059983. View

14.

Thomas R, Balady G, Banka G, Beckie T, Chiu J, Gokak S . 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2018; 71(16):1814-1837. DOI: 10.1016/j.jacc.2018.01.004. View

15.

Abraham L, Sibilitz K, Berg S, Tang L, Risom S, Lindschou J . Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database Syst Rev. 2021; 5:CD010876. PMC: 8105032. DOI: 10.1002/14651858.CD010876.pub3. View

16.

Goodlin S . Palliative care in congestive heart failure. J Am Coll Cardiol. 2009; 54(5):386-96. DOI: 10.1016/j.jacc.2009.02.078. View

17.

Redfern J, Gallagher R, ONeil A, Grace S, Bauman A, Jennings G . Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future. Front Cardiovasc Med. 2022; 9:842567. PMC: 9091441. DOI: 10.3389/fcvm.2022.842567. View

18.

Straw S, McGinlay M, Witte K . Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction. Open Heart. 2021; 8(1). PMC: 7929859. DOI: 10.1136/openhrt-2021-001585. View

19.

Uddin J, Zwisler A, Lewinter C, Moniruzzaman M, Lund K, Tang L . Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: A meta-regression analysis. Eur J Prev Cardiol. 2015; 23(7):683-93. DOI: 10.1177/2047487315604311. View

20.

Dalal H, Doherty P, McDonagh S, Paul K, Taylor R . Virtual and in-person cardiac rehabilitation. BMJ. 2021; 373:n1270. PMC: 8176835. DOI: 10.1136/bmj.n1270. View