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Cardiac rehabilitation utilization, barriers, and outcomes among patients with heart failure

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Abstract

Exercise-based cardiac rehabilitation (CR) is effective for improving both primary (i.e., mortality and hospitalizations) and secondary (i.e., functional capacity and quality of life among) clinical outcomes among patients with heart failure (HF). The mechanisms that explain these benefits are complex and are linked to exercise adaptations such as central and peripheral hemodynamics combined with improved overall medical management. Despite the benefits of CR, utilization rates are low among CR eligible patients. Clinician-, patient-, and health system-related barriers have been identified as primary factors contributing to the lack of CR utilization among HF patients. These include patient referrals (clinician-related), psychosocial factors (patient-related), and patient access to CR services (health system-related). The aims of this review are to detail the components of each barrier as well as identify evidence-based strategies to improve CR utilization and adherence among HF. The improvements in primary and secondary outcomes along with the mechanisms that are linked to these changes will also be examined.

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Authors and Affiliations

  1. School of Health Sciences, Central Michigan University, Mt. Pleasant, MI, USA

    Rachael K. Nelson, Emily Hosmer & Micah Zuhl

  2. Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA

    Robert Solomon

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  1. Rachael K. Nelson
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  2. Robert Solomon
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  3. Emily Hosmer
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  4. Micah Zuhl
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Contributions

All authors contributed to the conceptualization of the manuscript; MZ completed introduction and outcomes sections; EH completed the cardiac utilization section; RS completed the medical management section; RN completed the biological mechanisms section; All authors reviewed and edited the manuscript.

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Correspondence to Micah Zuhl.

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Nelson, R.K., Solomon, R., Hosmer, E. et al. Cardiac rehabilitation utilization, barriers, and outcomes among patients with heart failure. Heart Fail Rev 28, 1239–1249 (2023). https://doi.org/10.1007/s10741-023-10309-2

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