Multiple studies have demonstrated the safety, benefits and cost-effectiveness of cardiac rehabilitation in patients with heart failure (HF), however, it remains underused. A new perspective from the ACC Heart Failure and Transplant Section Leadership Council, published March 15 in the Journal of the American College of Cardiology, reviews existing evidence and guidelines, and provides guidance for the implementation of cardiac rehabilitation in patients with HF.

Biykem Bozkurt, MD, PhD, FACC, et al., describe how cardiac rehabilitation programs have shifted from a monitored exercise program to a comprehensive and multidisciplinary program over the past three decades. A cardiac rehabilitation program includes exercise training, patient assessment, education about medication adherence, risk factor modification including dietary recommendation, lifestyle modification, smoking cessation counseling, stress management, and evaluation and management of barriers to adherence.

The perspective reviews the etiology and reversibility of exercise intolerance in patients with HF; barriers and limitations to implementation of cardiac rehabilitation; evidence of benefits from different exercise types in patients with HF; how to develop an exercise training prescription and recommendations; development of the nonexercised components of cardiac rehabilitation; new models of care and proposed changes for coverage of cardiac rehabilitation; and more.

The authors recommend that clinicians, health care leaders and payers incorporate cardiac rehabilitation into the standard of care for patients with HF. "The practical guidance, along with existing and emerging data, and strategies to improve referrals, adheres, and coverage for [cardiac rehabilitation] provided in this document should be helpful in the implementation of [cardiac rehabilitation] in the care of patients with [heart failure]," write the authors.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Cardiac Rehabilitation, Cost-Benefit Analysis, Leadership, Smoking Cessation, Standard of Care, Exercise, Exercise Therapy, Heart Failure, Counseling, Cardiology, Risk Factors, Medication Adherence, Life Style, Prescriptions, Referral and Consultation

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