Exercise-Based Cardiac Rehabilitation for Adults With Heart Failure

CLINICAL QUESTION

Does exercise-based cardiac rehabilitation improve mortality rates, hospital admission rates, and health-related quality of life in adults who have heart failure (HF) with reduced or preserved ejection fraction?

EVIDENCE-BASED ANSWER

Exercise-based cardiac rehabilitation likely reduces the risk of all-cause hospital admission in adults who have HF with reduced or preserved ejection fraction.¹ (Strength of Recommendation [SOR]: A, consistent, good-quality patient-oriented evidence.) Exercise-based cardiac rehabilitation likely improves short-term health-related quality of life in adults with HF with reduced or preserved ejection fraction. (SOR: A, consistent, good-quality patient-oriented evidence.) Exercise-based cardiac rehabilitation does not decrease short-term (up to 12 months) all-cause mortality compared with usual care in adults who have HF with reduced or preserved ejection fraction. (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

HF is a common condition affecting more than 60 million people worldwide.^1,2 HF is a clinical syndrome with signs and/or symptoms caused by structural and/or functional cardiac abnormalities.³ In this Cochrane review, patients who had HF with preserved ejection fraction (HFpEF) were defined as having an ejection fraction of 45% or greater, and patients with HF with reduced ejection fraction (HFrEF) were defined as having an ejection fraction of less than 45%.¹ Patients with HF often experience a significant reduction in exercise capacity, which can negatively affect quality of life. Exercise-based cardiac rehabilitation is an underused treatment for cardiovascular disease to improve HF symptoms and related outcomes.⁴ Exercise-based cardiac rehabilitation always includes formal exercise training but may also include education on lifestyle and risk factor modification, counseling, and psychosocial support.^1,4 It typically is conducted in person but also may be implemented through home-based models or technology-based models, which may increase access to this intervention.⁴