Comprehensive cardiac rehabilitation utilized to support patients with heart failure for balancing treatment and work: A case report

A 47-year-old woman with exertional dyspnea was admitted to our hospital. Echocardiography revealed congestive heart failure (HF), with reduced left ventricular ejection fraction (13 %) and elevated brain natriuretic peptide levels (877 pg/mL). The patient underwent medical therapy and comprehensive cardiac rehabilitation (CR). At discharge, the oxygen uptake at anaerobic threshold (AT) was 13.1 mL/kg/min. Outpatient CR consisted of exercise therapy, patient education, and home activity intensity instructions with pulse rate (PR) management using a wearable device. We instructed that activity intensity at home should not exceed the PR at AT. Two months after discharge, the patient's condition was stable, and she was compliant with activity intensity restrictions; therefore, she was allowed to return to work twice a week for 5 h of light work weekly, which was gradually increased. We continued to monitor the PR with wearable devices to ensure compliance with work intensity. Five months after discharge, she achieved a return to work four times a week for 8 h without exacerbation of HF symptoms. The workplace was receptive to the suggestions of the CR team regarding workplace conditions, safe working hours, and frequency, and the patient successfully returned to work, achieving a balance between treatment and work. Learning objective: The use of comprehensive cardiac rehabilitation is recommended for the return to work by patients with heart failure. However, specific measures to manage activity intensity for return to work have not been considered fully. The strategy that we adopted involved a combination of comprehensive cardiac rehabilitation and the use of wearable devices for guided work intensity management, allowing for a balance between treatment and work responsibilities.