Latest updates on structure and recommendations of cardiac rehabilitation programs in chronic heart failure

Abstract

Chronic heart failure (HF) is a clinical syndrome with high morbidity and mortality worldwide. Cardiac rehabilitation (CR) is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF, recommended by both American and European guidelines. A CR program consists of a multispecialty group including physicians, nurses, physiotherapists, trainers, nutritionists, and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF patients. Physical activity, lifestyle, and psychological support are core components of a successful CR program. CR has been shown to be beneficial in all ejection fraction categories in HF and most patients, who are stable under medication, are capable of participating. An individualized exercise prescription should be developed on the basis of a baseline evaluation in all patients. The main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and frequency. It is important to set the appropriate clinical outcomes from the beginning, in order to assess the effectiveness of a CR program. There are still significant limitations that prevent patients from participating in these programs and need to be solved. A significant limitation is the generally low quality of research in CR and the presence of negative trials, such as the rehabilitation after myocardial infarction trial, where comprehensive rehabilitation following myocardial infraction had no important effect on mortality, morbidity, risk factors, or health-related quality of life or activity. In the present editorial, we present all the updated knowledge and recommendations in CR programs.

Keywords: Cardiac rehabilitation; Heart failure; Outcomes; Exercise protocols; Prescription; Future perspectives; Limitations

Core Tip: Cardiac rehabilitation (CR) is a medically supervised program designed to maintain or improve cardiovascular health of patients with heart failure (HF), recommended by guidelines. CR has been shown to be beneficial in HF, leading to improvements in central hemodynamic status and peripheral vascular, endothelial, and skeletal muscle function and, most significantly, in peak and submaximal exercise capacity, cardiorespiratory fitness, and quality of life. Main endpoints of a CR program include a wide spectrum of functional and psychological variables. Despite the strong recommendations in the guidelines, the attendance rates remain at low levels due to several barriers related to healthcare professionals, patients, and states.