Cardiac rehabilitation of patients with heart failure
ELSAN – Polyclinique de Poitiers, France
Cardiac rehabilitation (CR) in heart failure (HF) improves exercise capacity and quality of life, reduces rehospitalizations, and prolongs survival. Systematic referral of HF patients to CR, especially during the vulnerable phase after a congestive episode, is strongly recommended. However, CR in HF is still largely underused.
CR is a multidisciplinary approach of complete secondary prevention that can be realized in most HF patients on an outpatient basis in 2-3 months. The CR team includes cardiologists, physiotherapists, dieticians, HF nurses, social workers, and psychologists.
Cardiopulmonary exercise testing (CPX) is a fundamental tool to evaluate the impaired exercise capacity and oxygen uptake of HF patients. The core component of the CR program is individually tailored exercise training (ET) with endurance and resistance training units. During CR, the patients benefit from an efficient adaptation of pharmacotherapy by HF specialists, individual and group-based patient education, dietary counselling, structured tobacco cessation programs, and psycho-social support.
The beneficial effects of ET are both cardiac and peripheral, including reduction of resting heart rate by improved control of autonomic imbalance, increase of the chronotropic reserve, decrease of peripheral vascular resistance, and improved aerobic metabolism of the skeletal muscle resulting in increased endurance and force.
Key unresolved issues remain the low referral rate of HF patients to CR by acute care cardiologists, the limited capacity of CR centers to absorb all referred patients, and especially the difficulties to motivate HF patients to maintain a sufficient level of physical activity after discharge from CR.