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Failure
HFpEF HFrEF
Risk factors need to be continually addressed when managing a patient with HF:
hypertension, lipid disorders, obesity, diabetes mellitus, tobacco use, and known
cardiotoxic agents.
Aim for control of systolic and diastolic blood pressures, as well as volume status, to treat
HFpEF.
Re-evaluate patients with left ventricular EF ≤35%, New York Heart Association class II-IV, left
bundle branch block, and a QRS ≥150 ms for cardiac resynchronization therapy.
HF education, dietary restrictions, and exercise training should be provided for all patients
to enhance self-care.
Yancy, CW et al.
2013 ACCF/AHA Heart Failure Guideline
Nonpharmacological Interventions (cont.)
I IIa IIb III
Continuous positive airway pressure (CPAP) can be beneficial
to increase LVEF and improve functional status in patients
with HF and sleep apnea.
Yancy, CW et al.
2013 ACCF/AHA Heart Failure Guideline, Circulation. 2013;128:000–000
ESC Guideline, 2012
Exercise training resulted in nonsignificant reductions in
the primary end point of all-cause mortality or
hospitalization and in secondary clinical end points
Role of Exercise Training in HF
Current Guidelines 2013:
◦ Class I
Exercise training (or regular physical activity) is recommended as safe and
effective for patients with HF who are able to participate to improve functional
status
(Level of Evidence: A)
◦ Class IIa
Cardiac rehabilitation can be useful in clinically stable patients with HF to
improve functional capacity, exercise duration, HRQOL, and mortality.
(Level of Evidence: B)
Benefits with exercise and cardiac rehabilitation
• Improvement in exercise capacity after exercise training due to
peripheral adaptations (increased oxygen extraction)
• Improvement in quality of life
• Reduced hospitalizations and mortality
• Improved endothelial function
• Reduction in catecholamine levels
Walking
Swimming
yoga
Interval training
Flexibility and resistance training
Tami Ward MS, 2013, Exercise and Heart Failure
Monitor and reduce fluid retention
• Advise all patients with symptomatic heart failure to limit their salt intake in
to 2-3 g daily (“no added salt”). [Level of Evidence: Class I, Level C]
• Advise those with more advanced heart failure and fluid retention to limit
their salt intake to 1-2 g daily (“low-salt”). [Level of Evidence: Class I, Level C]