Chapter

Cardiac rehabilitation and chronic heart failure

Massimo F. Piepoli and Andrew L. Clark

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0045

Series: Oxford Textbooks

Cardiac rehabilitation and chronic heart failure

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All patients with established chronic heart failure (CHF), with orwithout an implantable cardioverter defibrillator (ICD) and with orwithout cardiac resynchronization therapy (CRT), require a multifactorialcardiac rehabilitation (CR) approach. The role of the multidisciplinaryapproach is considered elsewhere.The traditional model of care delivery is thought to contribute tofrequent hospitalizations. During these brief episodic encounters,little attention is paid to the numerous barriers to effective CHFtreatment and the possible treatment of the common modifiablefactors that are the cause of disease progression and thus hospitalreadmissions. To face these limitations, a CHF disease multidimensionalmanagement programme is necessary to curb the risingcost of management and to improve morbidity and mortality for individual patients. CR is the ideal comprehensive structured disease interventionsince it best addresses the complex interplay of medical, psychological,and behavioural factors facing CHF patients. It is a coordinatedmultidimensional intervention designed to stabilize orslow disease progression, alleviate symptoms, improve exercisetolerance, and enhance quality of life, thereby reducing morbidity and mortality. In CHF populations, such a programme has beenproven to improve functional capacity, recovery and emotionalwell-being and to reduce hospital admissions in CHF patients.Exercise training as a key component in a CR programme mayimprove survival and reduce hospitalization in stable heart failure(HF) patients. It is recommended for all stable CHF patients. Thereis no evidence that it should be limited to any particular HF patientsubgroup based on aetiology, NYHA class, left ventricular function,or medication (class of recommendation I, level of evidence A).Despite the virtues of CR, only a small percentage of eligible HFpatients ever get referred, due to barriers such as lack of physicianand patient-family awareness of its benefits, and logistical or financialconstraints. Patients with CHF are a patient population thatchallenges CR with the need to employ active strategies to disseminateand implement appropriate standards of care.

Chapter.  7883 words.  Illustrated.

Subjects: Cardiovascular Medicine

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