title: Heart Failure as a Newly Approved Diagnosis for Cardiac Rehabilitation: Challenges and Opportunities.
abstract: 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.
authors.affiliation: Geriatric Research, Education, and Clinical Center and Division of Cardiology, University of Pittsburgh Medical Center and the Veterans Administration Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: formand@pitt.edu.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.affiliation: Department of Medicine, Divisions of Cardiology and Geriatric Medicine, Auburn University School of Nursing, Auburn, Alabama.
authors.forename: Bonnie K
authors.initials: BK
authors.lastname: Sanderson
authors.affiliation: Department of Medicine, Harrington Heart & Vascular Institute, University Hospitals Health System, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Josephson
authors.affiliation: University Hospitals Health System, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Jayant
authors.initials: J
authors.lastname: Raikhelkar
authors.affiliation: Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic / Q000379:methods; D019468:Disease Management; D005081:Exercise Therapy / Q000379:methods / Q000639:trends*; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
keywords: adherence; exercise training; randomized controlled trial