Non-Pharmacological Treatment Approaches

The Treatment of Heart Failure With Reduced Ejection Fraction by Dr. med. Dominik Berliner, Dr. med. Anja Hänselmann, Prof. Dr. med. Johann Bauersachs in issue 21/2020

In the article “The treatment of heart failure with reduced ejection fraction“ by Berliner et al. (1), the evidence related to pharmacotherapy is presented in a comprehensive and very up-to-date fashion. In addition, device-based therapies and interventional procedures are critically discussed. We would like to draw the attention to another evidence-based treatment option for systolic heart failure: cardiac rehabilitation (“KardReha”).

Non-pharmacological treatment approaches, such as physical training, education on coping with the disease and improving treatment adherence as well as targeted psychosocial support are recommended in the guidelines of the specialist societies as “multidisciplinary management“ for patients with systolic heart failure, supported by the highest level of evidence. (ESC 2016: IA, ACC/AHA 2017: IA) A current clinical practice (S3) guideline on cardiological rehabilitation in German-speaking areas of Europe (2) and the German National Disease Management Guideline Heart Failure (3) both recommend cardiac rehabilitation for patients with heart failure and reduced ejection fraction, again supported by the highest level of evidence.

Quite rightly, the authors point out that heart failure is also associated with a relevant reduction in quality of life (1). Current meta-analyses and a Cochrane Review demonstrate significant improvements in physical fitness and quality of life of these patients associated with participation in a cardiac rehabilitation program. Consequently, cardiac rehabilitation should be an integral component of the evidence-based treatment of heart failure with reduced ejection fraction, besides pharmacotherapy, device-based therapies and interventional procedures.

DOI: 10.3238/arztebl.m2021.0046

Dr. med. Eike Langheim
Reha-Zentrum Seehof
Teltow bei Berlin
Dr. med. [e-mail]

Prof. Dr. med. Bernhard Schwaab
Curschmann Klinik
Timmendorfer Strand

Germany

Conflict of interest

The authors declare no conflict of interest.

References

1. Berliner D, Hänselmann A, Bauersachs J: The treatment of heart failure with reduced ejection fraction. Dtsch Arztebl Int 2020; 117: 376–86

2. S3-Leitlinie zur kardiologischen Rehabilitation im deutschsprachigen Raum Europas (D-A-CH). 07.01.2020, AWMF-Registernummer: 133–001 .

3. Nationale Versorgungsleitlinie: Chronische Herzinsuffizienz 3rd. edition, 2019. Version 2. www.leitlinien.de/nvl/herzinsuffizienz (last accessed on 11. August 2020).