- Howlett J.G.
- McKelvie R.S.
- Costigan J.
- et al.
- Malcom J.
- Arnold O.
- Howlett J.G.
- et al.
Rehabilitation and Exercise in HF
Exercise training in patients with HF
- 1.We recommend that all patients with stable New York Heart Association (NYHA) class I-III symptoms be considered for enrollment in a supervised tailored exercise training program, to improve exercise tolerance and quality of life (Strong Recommendation, Moderate-Quality Evidence).
- 2.We recommend that an assessment of clinical status by a clinician experienced in the management of HF patients be completed before considering an exercise training program (Strong Recommendation, Low-Quality Evidence).
Adherence to exercise
Safety of exercise
Cardiac rehabilitation programs for patients with recently decompensated or advanced HF
- 1.We recommend that gradual mobilization and/or small muscle group strength/flexibility exercises be considered as soon as possible either alone or in combination for patients with NYHA class IV symptoms or recently decompensated HF. This should be considered only in consultation with an experienced HF team (Strong Recommendation, Low-Quality Evidence).
Cardiac rehabilitation in HF with preserved ejection fraction
Cardiac rehabilitation in patients with cardiac resynchronization therapy and implantable cardioverter defibrillators
- Isaksen K.
- Morken I.M.
- Munk P.S.
- Larsen A.I.
Exercise in frail seniors with HF
Exercise prescription and exercise modalities in HF
- 1.We recommend moderate-intensity continuous aerobic exercise training (eg, brisk walking, jogging, and cycling) at rate of Borg Rating Perceived Exertion (RPE) scale 3-5, 65%-85% maximum HR, or 50%-75% of peak VO2 in patients with HF (Strong Recommendation, Moderate-Quality Evidence).
|Flexibility exercises||Discharged with heart failure||NYHA I-III||NYHA IV|
|10-20 repetitions of 5- to 10-pound free weights|
2-3 days per week
Aerobic training: continuous and interval training
Aerobic exercise training intensity
Surgical Coronary Revascularizatioin in HF
- 1.We recommend that noninvasive imaging for patients with HF be considered to determine the presence or absence of coronary artery disease (CAD) (Strong Recommendation, Moderate-Quality Evidence).
- 2.We recommend that coronary angiography be:
- i.Performed in patients with HF with ischemic symptoms and who are likely to be good candidates for revascularization (Strong Recommendation, Moderate-Quality Evidence).
- ii.Considered in patients with systolic HF, LVEF < 35%, at risk of CAD, irrespective of angina, who might be good candidates for revascularization (Strong Recommendation, Low-Quality Evidence).
- iii.Considered in patients with systolic HF and in whom noninvasive coronary perfusion testing yields features consistent with high risk (Strong Recommendation, Moderate-Quality Evidence).
- Wright R.S.
- Anderson J.L.
- Adams C.D.
- et al.
- Shaw L.J.
- Berman D.S.
- Maron D.J.
- et al.
Diagnosis of CAD in patients with HF
- Hachamovitch R.
- Hayes S.W.
- Friedman J.D.
- Cohen I.
- Berman D.S.
Imaging for reversible ischemia as a guide to the presence of CAD
- Hachamovitch R.
- Hayes S.W.
- Friedman J.D.
- Cohen I.
- Berman D.S.
Imaging for hibernating myocardium
- •Reversible ischemia or a large segment of viable myocardium (> 30% of the left ventricle) in nuclear stress testing/viability study;
- •Reversible ischemia or > 7% hibernating myocardium on PET scanning;
- •Reversible ischemia or > 20% of the left ventricle shown as viable using DSE;
- •< 50% wall thickness scarring shown by late gadolinium enhancement on CMR imaging.
Disease management, referral, and perioperative care
- 1.We recommend that the decision to refer patients with HF and ischemic heart disease for coronary revascularization should be made on an individual basis and in consideration of all cardiac and noncardiac factors that affect procedural candidacy (Strong Recommendation, Low-Quality Evidence).
- 2.We recommend that efforts be made to optimize medical status before coronary revascularization, including optimizing intravascular volume medical therapy (Strong Recommendation, Low-Quality Evidence).
- 3.We recommend that performance of coronary revascularization procedures in patients with chronic HF and reduced LVEF be undertaken with a medical-surgical team approach with experience and expertise in high-risk interventions (Strong Recommendation, Low-Quality Evidence).
Surgical revascularization for patients with CAD and HF
- 1.We recommend consideration of coronary artery bypass surgery for patients with chronic ischemic cardiomyopathy, LVEF < 35%, graftable coronary arteries, and who are otherwise suitable candidates for surgery, irrespective of the presence of angina and HF symptoms to improve quality of life, and reduce rates of cardiovascular death and hospitalization (Strong Recommendation, Moderate-Quality Evidence).
- 2.We suggest consideration of PCI for patients with HF and limiting symptoms of cardiac ischemia, and for whom coronary artery bypass grafting (CABG) is not considered appropriate (Conditional Recommendation, Low-Quality Evidence).
- 3.We recommend against routine performance of surgical ventricular restoration for patients with HF undergoing CABG who have akinetic or dyskinetic segments (Strong Recommendation, Moderate-Quality Evidence).
The STICH trial
Device considerations in HF patients after cardiac surgery
- 1.We recommend that after successful cardiac surgery, patients with HF undergo assessment for implantable cardiac devices within 3-6 months of optimal treatment (Strong Recommendation, High-Quality Evidence).
- 2.We recommend that patients with implantable cardiac devices in situ should be evaluated for programming changes before surgery and again after surgery, in accordance with existing CCS recommendations (Strong Recommendation, Low-Quality Evidence).
- 3.We recommend that after successful cardiac surgery, all patients be referred to a local cardiac rehabilitation program (Strong Recommendation, High-Quality Evidence).
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- Hallstrom A.P.
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This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.