Heart Failure as a Newly Approved Diagnosis for Cardiac Rehabilitation: Challenges and Opportunities

J Am Coll Cardiol. 2015 Jun 23;65(24):2652-2659. doi: 10.1016/j.jacc.2015.04.052.


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.

Keywords: adherence; exercise training; randomized controlled trial.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Animals
  • Clinical Trials as Topic / methods
  • Disease Management*
  • Exercise Therapy / methods
  • Exercise Therapy / trends*
  • Heart Failure / diagnosis*
  • Heart Failure / epidemiology
  • Heart Failure / rehabilitation*
  • Humans
  • Stroke Volume / physiology
  • Treatment Outcome