Cardiac Rehabilitation in Heart Failure

Abstract

Heart failure (HF) is a complex clinical syndrome caused by a structural and/or functional cardiac abnormality, resulting in reduced organ perfusion. The goals of treatment in patients with HF are to improve functional capacity and quality of life, and to reduce mortality. Cardiac rehabilitation (CR) including exercise training is one of the treatment options, and current guidelines recommend CR as safe and effective for patients with HF. CR has been known to improve exercise capacity and quality of life, minimize HF progression, and lower mortality in patients with HF. Improvement of vascular endothelial function, activation of the neurohormonal system, increase of mitochondrial oxygen utilization in peripheral muscles, and increase of chronotropic responses are possible mechanisms of the beneficial effects of exercise-based CR in HF. Although CR has been shown to decrease morbidity and mortality, it is underutilized in clinical practice. Despite the existence of concrete evidence of clinical benefits, the CR participation rates of patients with HF range from only 14% to 43% worldwide, with high dropout rates after enrollment. These low participation rates have been attributed to several barriers, including patient factors, professional factors, and service factors. The motivation for participating in CR and for overcoming the patients' barriers for CR before discharge should be provided to each patient. Current guidelines strongly recommend applying a CR program to all eligible patients with HF.

Effect of Cardiac Rehabilitation on Left Ventricular Diastolic Function in Patients with Acute Myocardial Infarction

“…Acute myocardial infarction (AMI) is the most common cause of acute heart failure, and prompt management of the acute phase in AMI patients is mandatory to prevent the transition of acute heart failure to chronic heart failure [ 1 ]. Along with coronary revascularization and anti-ischemic pharmacotherapy, cardiac rehabilitation (CR) is the best adjunctive modality associated with the improvement of symptoms and survival in patients with AMI [ 2 , 3 ]. Comprehensive CR is an out-patient disease management program that reduces CV mortality by approximately 25% and hospital readmissions by 18% [ 4 , 5 ].…”

Ganhos com o programa de reabilitação e ensino à pessoa com insuficiência cardíaca (Programa REPIC)

“…Embora os programas de RC tenham demonstrado muitos benefícios clínicos, as taxas de participação dos clientes com IC variam entre 14% a 43% em todo o mundo, estando igualmente associados a elevadas taxas de abandono (26) . Da mesma forma, a adesão ao exercício físico na pessoa com IC constitui um desafio, apesar dos benefícios do mesmo na capacidade funcional da pessoa com IC e já citados anteriormente (11)(13)(15)(24) (25) .Tendo por base os resultados do programa REPIC, verificou-se um aumento na duração média do tempo despendido na realização de exercício físico.…”

Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study

“…For decades, the implementation of the CR program in patients with HFrEF has been challenging ( 34 ). Patients with HFrEF, especially those discharged from the hospital, are prone to arrhythmias, hemodynamic instability, and fluid overload, and are often older and frailer.…”