Cardiac rehabilitation in heart failure patients with devices
Dr Marie Christine ILIOUa
a Hôpital Universitaire Paris Ouest . Hôpital Corentin celton
Cardiac rehabilitation (CR) for heart failure by systolic dysfunction benefits from a recommendation of level IA by all the scientific societies. The main core components of CR include: evaluation, personalized physical training, patient education, treatments optimization and psycho-social counselling. Heart failure patients are sometimes, and more and more often, implanted by simple or sophisticated pacemakers, resynchronization and/or automatic defibrillators for rhythm and/or hemodynamic indications.
The management of these patients requires the knowledge of the functioning of every device, constraints and limits of these and risks associated to the disease and to the equipment in different situations. The cardiologic evaluation at exercise by a cardiopulmonary exercise test will allow the prescription of the training but it happens that some adjustments of the settings are required. The demonstrated benefits of exercise training are an improvement of exercise capacities, and consequently of quality of life and also a reduction on re-hopitalizations. If education is mandatory for all the heart failure patients, in implanted patients specific knowledge and behavior modifications were also implemented. Optimization of the treatments needs to take on account the patient profile. Psychological consequences (particularly for implanted cardiac defibrillators) should be managed and possibilities to return to a as normal of possible life (including return to work) evaluated.
Accordingly, management of implanted heart failure patients requires a specific skills and cardiologic supervision adapted to the patient situation.
Keywords : cardiac rehabilitation - exercise - pacemakers - resynchronization- implanted cardiac defibrilators