From the Guidelines
A referral to cardiac rehabilitation is strongly warranted for a newly diagnosed heart failure patient. Cardiac rehabilitation provides a comprehensive, medically supervised program that includes exercise training, education on heart-healthy living, and counseling to reduce stress and help patients return to an active lifestyle. The program typically consists of 36 sessions over 12 weeks, with patients attending 2-3 sessions per week. Each session usually includes monitored exercise (walking, cycling, or other aerobic activities at appropriate intensity), along with education about medication adherence, dietary modifications (particularly sodium restriction to 2-3g daily), and self-monitoring techniques such as daily weight checks and symptom recognition.
Key Benefits of Cardiac Rehabilitation
- Improves exercise capacity
- Enhances quality of life
- Reduces hospitalizations in heart failure patients
- Helps patients understand their condition
- Optimizes medication benefits
- Develops sustainable lifestyle modifications
- Provides psychological support, which is crucial as depression and anxiety are common in heart failure patients As noted in the study by 1, exercise training is significantly underused in patients with heart failure, and several strategies have been proposed to address this implementation gap. The study by 1 also highlights the importance of exercise-based cardiac rehabilitation in improving exercise capacity and quality-of-life in heart failure patients.
Implementation and Accessibility
- Efforts are warranted to promote and implement exercise-based therapies for heart failure patients
- Strategies to increase access to exercise-based programs and methods to facilitate adherence are needed
- Existing disparities, such as lower participation among women and Black patients, must be addressed Early referral after diagnosis allows patients to establish healthy habits that can slow disease progression and improve long-term outcomes.
From the Research
Cardiac Rehabilitation for Heart Failure Patients
- Cardiac rehabilitation is a cornerstone therapy for heart failure patients, with established benefits in improving long-term mortality and hospitalization rates, as well as enhancing quality of life and medical therapy adherence 2.
- Exercise-based cardiac rehabilitation has been shown to improve outcomes in heart failure with reduced ejection fraction (HFrEF), with less evidence available for heart failure with preserved ejection fraction (HFpEF) 3.
- Referral to cardiac rehabilitation is an important step in ensuring that patients receive this beneficial therapy, with studies suggesting that systematic referral can improve participation rates 4.
Factors Influencing Referral to Cardiac Rehabilitation
- Healthcare professional, system, and patient factors can influence referrals to cardiac rehabilitation, including low knowledge or skepticism about benefits, over-reliance on physicians as gatekeepers, and judgments that patients are not likely to participate 5.
- Systematic referral, allowing referral from non-physicians, or automatic referral to a choice of hospital or home-based programs can increase patient referral to cardiac rehabilitation programs 5.
- Factors such as age, diagnosis, previous cardiovascular disease, and left ventricular dysfunction can also influence referral and participation rates 4.
Referral to Cardiac Rehabilitation for Newly Diagnosed Heart Failure Patients
- Guideline-directed medical therapy (GDMT) is essential for newly diagnosed heart failure patients, and referral to an HF clinic can improve the initiation of GDMT 6.
- Cardiac rehabilitation can be an important component of secondary prevention for heart failure patients, with benefits in improving mortality, hospitalization rates, and quality of life 2, 3.
- Referral to cardiac rehabilitation should be considered for all newly diagnosed heart failure patients, taking into account individual patient factors and comorbidities 2, 3.