Key result
Exercise cardiac rehabilitation improves exercise capacity and quality of life in HFrEF despite low enrollment.
Why the study?
Exercise cardiac rehabilitation is an evidence-based therapy for patients with HFrEF, but few patients enroll, warranting a concise review of exercise testing, rehabilitation literature, and unique care aspects.
Does exercise cardiac rehabilitation improve exercise capacity and clinical outcomes in patients with HFrEF?
Does exercise cardiac rehabilitation improve exercise capacity and clinical outcomes in patients with HFrEF?
Exercise cardiac rehabilitation is an evidence-based therapy that improves exercise capacity, quality of life, and clinical outcomes in patients with HFrEF, though it remains underutilized.
Supports referral to exercise cardiac rehabilitation in HFrEF; leaves open strategies to address low enrollment.
PURPOSE: Exercise cardiac rehabilitation (CR) represents an evidence-based therapy for patients with heart failure with reduced ejection fraction (HFrEF) and this article provides a concise review of the relevant exercise testing and CR literature, including aspects unique to their care. CLINICAL CONSIDERATIONS: A hallmark feature of HFrEF is exercise intolerance (eg, early-onset fatigue). Drug therapies for HFrEF target neurohormonal pathways to blunt negative remodeling of the cardiac architecture and restore favorable loading conditions. Guideline drug therapy includes β-adrenergic blocking agents; blockade of the renin-angiotensin system; aldosterone antagonism; sodium-glucose cotransport inhibition; and diuretics, as needed. EXERCISE TESTING AND TRAINING: Various assessments are used to quantify exercise capacity in patients with HFrEF, including peak oxygen uptake measured during an exercise test and 6-min walk distance. The mechanisms responsible for the exercise intolerance include abnormalities in ( a ) central transport (chronotropic response, stroke volume) and ( b ) the diffusion/utilization of oxygen in skeletal muscles. Cardiac rehabilitation improves exercise capacity, intermediate physiologic measures (eg, endothelial function and sympathetic nervous system activity), health-related quality of life (HRQoL), and likely clinical outcomes. The prescription of exercise in patients with HFrEF is generally similar to that for other patients with cardiovascular disease; however, patients having undergone an advanced surgical therapy do present with features that require attention. SUMMARY: Few patients with HFrEF enroll in CR and as such, many miss the derived benefits, including improved exercise capacity, a likely reduction in risk for subsequent clinical events (eg, rehospitalization), improved HRQoL, and adoption of disease management strategies.
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Keteyian et al. (2022) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Exercise cardiac rehabilitation was evaluated. Exercise cardiac rehabilitation improves exercise capacity and health-related quality of life in patients with heart failure with reduced ejection fraction, though clinical enrollment remains low.
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