Cardiac Rehabilitation Has Important Benefits for Both HFpEF and HFrEF Patients

Abstract

Introduction The benefits and safety of cardiac rehabilitation (CR) for heart failure with reduced ejection fraction (HFrEF) demonstrated in research studies led to the decision by the Centers for Medicare & Medicaid Services (CMS) to fund CR for HFrEF. Evidence of the value of CR for heart failure with preserved ejection fraction (HFpEF) remains limited, and CR funding for HFpEF has not been approved by CMS. Many HFpEF patients are older and functionally impaired, therefore, theoretical rationale for exercise training in HFpEF remains compelling. At VA Pittsburgh Healthcare System (VAPHS), we compared HFrEF and HFpEF patients participating in CR. Methods HFrEF and HFpEF patients enrolled in a phase II CR program were compared. Thirty-two HF patients (19 HFrEF, 13 HFpEF) enrolled in the VAPHS Cardiac Rehab program completed post-CR assessments of physical function. Improvements in 6 Minute Walking Distance (6MWD) are described as mean + standard deviation (SD) and assessed with paired t-tests. Results CR was uniformly safe and well tolerated. Baseline data show HFpEF and HFrEF patients with significant functional impairments (HFpEF> HFrEF) including strength, balance, aerobic, and frailty domains. In all cases, HFpEF patients were more compromised than HFrEF (Table). Both HFpEF and HFrEF achieved clinical improvements in all domains through CR, including significant gains in 6MWD. Conclusion HFpEF patients start CR with worse functional status but derive similar benefits from CR as HFrEF patients. Further consideration should be given to reimbursement for CR in HFpEF patients.