Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review

Abstract

The purpose of this narrative review is to examine rehabilitation modalities for patients with heart failure and Frailty who require comprehensive intervention. Ischemic heart disease is the leading cause of death worldwide, accounting for 16% of global mortality. Due to population growing and aging, the total number of heart failure patients continues to rise, a condition known as the heart failure pandemic. Furthermore, frailty has been associated with an increased risk for heart failure and increased morbidity and mortality. The 2021 update of the 2017 ACC expert consensus decision pathway for optimization of HF treatment has become more concerning, citing frailty as one of the 10 most important issues associated with heart failure with reduced ejection fraction (HFrEF). Frailty and heart failure share common pathological mechanisms and are associated with poor clinical outcomes. Most studies of frailty in patients with heart failure primarily focus on physical frailty, and associations between psycho-psychological and social factors such as cognitive dysfunction and social isolation have also been reported. These results suggest that a more comprehensive assessment of frailty is important to determine the risk in patients with heart failure. Therefore, mechanisms of the three domains, including not only physical frailty but also cognitive, psychological, spiritual, and social aspects, should be understood. In addition to interventions in these three domains, nutritional and pharmacological interventions are also important and require tailor-made interventions for the widely varied conditions associated with heart failure and frailty. Although several studies have shown a relationship between frailty and prognosis in patients with heart failure, interventions to improve the prognosis have not yet been established. Further information is needed on frailty intervention by a multidisciplinary team to improve the prognosis.

The Effect and Possible Mechanism of Cardiac Rehabilitation in Partial Revascularization Performed on Multiple Coronary Artery Lesions

“… 52 This study found no significant difference in the levels of NO, NOS, SOD, and VEGF between two groups before training, while a significant improvement in two groups was found 1 year later, more obviously in the cardiac rehabilitation group, with a significant difference. It is possible that long-term cardiac rehabilitation training could increase the levels of NO and SOD in coronary artery endothelial cells, improve the endothelium-dependent vasodilatory function, promote vascular remodeling and angiogenesis, improve autonomic balance, and increase the blood flow perfusion of skeletal muscle via increasing oxygen extraction capacity, 53 which could improve myocardial ischemia-reperfusion injury, myocardioprotection, and reduce the level of VEGF. In addition, local release of NO can restrain intimal hyperplasia, down-regulate the levels of interleukin-6 and c-reactive protein significantly, reduce inflammation, and inhibit the development of in-stent restenosis.…”

Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures

“…There is a relationship between frailty and HF prognosis; however, interventions that improve prognosis are not yet well defined. Interventions aimed at improving the prognosis of multidomain frailty are needed [150].…”