Utility of Cardiac Rehabilitation Following Surgical Treatment of Infective Endocarditis

Infective endocarditis (IE) is a life-threatening cardiac infection. The incidence of IE is increasing due to complex sociodemographic shifts, including increases in intravenous drug use (IVDU) attributed to opioid epidemics. Cardiac rehabilitation (CR) is a comprehensive form of secondary prevention for heart disease. Current guidelines suggest that CR may be beneficial in the recovery from IE, but supporting evidence is limited. Given the utility of CR in the recovery from other cardiac conditions and the unique characteristics of patients with IE, this narrative review summarizes the existing data on the use of CR following surgical treatment of IE. The existing literature is limited to the CopenHeartIE randomized clinical trial (RCT) and four case reports. Thus, to our knowledge, this represents the first review to focus specifically on CR in the context of IE. The CopenHeartIE RCT found that patients receiving CR showed greater improvements in levels of physical fatigue, general fatigue, maximal power, systolic blood pressure, and some questionnaire scores than the control group. The results of multiple case reports represent unique and extreme cases of IE from which support for the use of CR following IE can be drawn from the relative successes of each patient. Moreover, it is important to consider that the complex social needs of the IE population may require additional psychosocial support, which can be achieved by integrating social workers into the multidisciplinary CR team. While further research is warranted, the existing evidence supports the use of CR as part of the comprehensive recovery from IE.