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Incorporating Patients With Chronic Heart Failure Into Outpatient Cardiac Rehabilitation: PRACTICAL RECOMMENDATIONS FOR EXERCISE AND SELF-CARE COUNSELINGA CLINICAL REVIEW

Keteyian, Steven J. PhD; Squires, Ray W. PhD; Ades, Philip A. MD; Thomas, Randal J. MD, MSc

Journal of Cardiopulmonary Rehabilitation & Prevention: July/August 2014 - Volume 34 - Issue 4 - p 223–232
doi: 10.1097/HCR.0000000000000073
Clinical and Scientific Reviews: Clinical Review

PURPOSE: A recent policy change from the Centers for Medicare and Medicaid Services includes coverage of cardiac rehabilitation (CR) for patients with chronic heart failure (CHF) with reduced ejection fraction. This article provides a framework by which CR programs can incorporate disease-specific services for patients with CHF who participate in CR.

DISCUSSION: Cardiac rehabilitation should include self-care counseling that targets improved education and skill development (eg, medication compliance, monitoring/management of body weight). Various tools are available for assessing exercise tolerance (eg, stress test with gas exchange and 6-minute walk), health-related quality of life, and other outcome-related parameters. Exercise should be prescribed in a manner that progressively increases intensity, duration, and frequency, to a volume of exercise equivalent to 3 to 7 metabolic equivalent task (MET)-hr per week. The benefits of exercise training are limited by patient adherence; therefore, CR providers need to identify the adherence challenges unique to each patient and address each accordingly. To optimize the referral of patients with CHF to CR, program staff should develop strategies to raise both health care provider and patient awareness about the benefits of CR, as well as work collaboratively to set up system-based approaches to CR referral.

CONCLUSIONS: The referral of patients with CHF to CR will increase in 2014 and beyond, due partly to a policy change from the Centers for Medicare and Medicaid Services that allows coverage for CR. These patients should be integrated into existing programs, with the intent of providing both standard CR services and CHF-specific education and disease management activities that target improved outcomes.

A policy change from the Centers for Medicare and Medicaid Services includes coverage of cardiac rehabilitation for patients with chronic heart failure with reduced ejection fraction. This article provides a framework by which programs can incorporate disease-specific services for patients, with an emphasis on prescribing exercise and disease management self-care.

Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan (Dr Keteyian); Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires and Thomas); and University of Vermont College of Medicine, Burlington, Vermont (Dr Ades).

Correspondence: Steven J. Keteyian, PhD, 6525 Second Ave, Detroit, MI 48202 (sketeyi1@HFHS.org).

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins