Heart Failure as a Newly Approved Diagnosis for Cardiac Rehabilitation

• Published in: Journal of the American College of Cardiology Vol. 65; no. 24; pp. 2652 - 2659
• Main Authors: Forman, Daniel E., MD, Sanderson, Bonnie K., PhD, RN, Josephson, Richard A., MS, MD, Raikhelkar, Jayant, MD, Bittner, Vera, MD, MSPH
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 23-06-2015; Elsevier Limited
• Subjects: Acute coronary syndromes; adherence; Atherosclerosis; Cardiology; Cardiovascular; Cardiovascular disease; Exercise; exercise training; Heart attacks; Heart failure; Internal Medicine; Investigations; Mortality; Patient Protection & Affordable Care Act 2010-US; Quality of life; randomized controlled trial; heart failure; VO 2; adherence; myocardial infarction; CMS; oxygen uptake; left ventricular assist devices; CPX; HFpEF; cardiopulmonary exercise testing; HFrEF; cardiac rehabilitation; LVAD; randomized controlled trial; CR; heart failure with preserved ejection fraction; exercise training; coronary heart disease; Center for Medicare Services; MI; heart failure with reduced ejection fraction; CHD; HF; VO2
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.04.052

Abstract Many see the broadened eligibility of cardiac rehabilitation (CR) to include heart failure with reduced ejection fraction (HFrEF) as a likely catalyst to high CR enrollment and improved care. However, such expectation contrasts with the reality that CR enrollment of eligible coronary heart disease patients has remained low for decades. In this review, entrenched obstacles impeding utilization of CR are considered, particularly in relation to potential HFrEF management. The strengths and limitations of the HF-ACTION (Heart Failure–A Controlled Trial Investigating Outcomes of Exercise Training) trial to advance precepts of CR are considered, as well as gaps that this trial failed to address, such as the utility of CR for patients with heart failure with preserved ejection fraction and the conundrum of poor patient adherence.