Surgical Innovations for Chronic Heart Failure in the Context of Cardiopulmonary Rehabilitation

According to 1998 data from the American Heart Association,1 approximately 4,900,000 Americans (2,500,000 men and 2,400,000 women) have been diagnosed with congestive heart failure (CHF), with approximately 400,000 new cases of CHF per year.1 The incidence of CHF approaches 10 cases per 1,000 people in the population after age 65 years, and CHF is the most frequent cause of hospitalization for people aged 65 years and older. Hospitalizations for CHF rose from 377,000 in 1979 to 872,000 in 1995. Approximately 20% of people who have sustained a myocardial infarction will be disabled with heart failure within 6 years of diagnosis.1 The reduction in mortality for people with other forms of cardiovascular disease, the increasing prevalence of CHF, and the rising median age of the US population suggest that the pool of patients who would require medical or surgical intervention will continue to expand well into the next century. In recent years, pharmacological management of CHF has benefited from the addition of angiotensin-converting enzyme (ACE) inhibitors and adrenergic beta-blockers, providing major symptomatic improvement in people with mild to moderate heart failure.2 Physical activity is likewise gaining acceptance as an important intervention.3 Structured exercise programs for people with cardiovascular and pulmonary disease have existed in the United States for nearly 3 decades, and the outcomes are well documented in the literature.4,5 In recent years, the emphasis and direction of research have shifted to the beneficial effects of both endurance training and resistive exercise for clinical and behavioral outcomes for patients with CHF. Exercise for patients with CHF is safe3 and results in physiological and psychological changes that lead to improved functional status. These improvements include improvements in control of heart rate,6–10 measures of quality of life,11–15 exercise …