The Effect of Cardiac Rehabilitation on Quality of Life And Functional Capacity in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Literature Review

Andry Dimas Dwiputra, Bayu Setia

Sari


ABSTRACT

 

Heart failure with reduced ejection fraction is a complex clinical syndrome that results in a significant decline in patients’ quality of life and functional capacity. Cardiac rehabilitation has been recognized as a comprehensive evidence-based intervention to address these issues. Objective: To systematically analyze the effect of cardiac rehabilitation on quality of life and functional capacity in patients with heart failure with reduced ejection fraction based on the latest literature. Methods: A systematic literature review was conducted using the PRISMA 2020 guidelines with searches performed in five major electronic databases for the publication period 2021–2025. The inclusion criteria comprised randomized controlled trials and quasi-experimental studies that evaluated the effectiveness of cardiac rehabilitation in adult patients with clinically stable HFrEF. Results: Thirty studies met the inclusion criteria with a total population of 84,064 patients. Cardiac rehabilitation showed a significant improvement in the KCCQ score with a mean increase of 18.4 points and a reduction in the MLHFQ score by 15.8 points. Functional capacity improved with an increase in peak VO2 of 3.2 mL/kg/min and an increase in 6MWT distance of 68.4 meters. Comprehensive programs showed a superior effect size compared to exercise-only interventions. Conclusion: Cardiac rehabilitation provides a clinically significant positive impact on the quality of life and functional capacity of patients with HFrEF, supporting its implementation as a standard of care with a comprehensive and individualized approach.

 

Keywords: Cardiac Rehabilitation, Heart Failure, Quality of Life, Functional Capacity, Systematic Review.


Teks Lengkap:

Download Artikel

Referensi


Adachi, T., Iritani, N., Kamiya, K., Iwatsu, K., Kamisaka, K., Iida, Y., & Yamada, S. (2022). Prognostic Effects of Cardiac Rehabilitation in Patients With Heart Failure (from a Multicenter Prospective Cohort Study). The American Journal of Cardiology, 164, 79–85. https://doi.org/10.1016/j.amjcard.2021.10.038

Bakker, E. A., van Bakel, B. M. A., Aengevaeren, W. R. M., Meindersma, E. P., Snoek, J. A., Waskowsky, W. M., van Kuijk, A. A., Jacobs, M. M. L. M., Hopman, M. T. E., Thijssen, D. H. J., & Eijsvogels, T. M. H. (2021). Sedentary behaviour in cardiovascular disease patients: Risk group identification and the impact of cardiac rehabilitation. International Journal of Cardiology, 326, 194–201. https://doi.org/10.1016/j.ijcard.2020.11.014

Belay Agonafir, D., Mulat Worku, B., Alemu, H., Nega Godana, T., Fentahun Bekele, S., Andargie Berhane, A., Getahun Ayalew, D., Sisay Assefa, B., Alemiye Molla, F., & Lema Legese, G. (2024). Health-related quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Hospital, Ethiopia. Frontiers in Cardiovascular Medicine, 11(August), 1–11. https://doi.org/10.3389/fcvm.2024.1436335

Beleigoli, A., Foote, J., Gebremichael, L. G., Bulamu, N. B., Astley, C., Keech, W., Tavella, R., Gulyani, A., Nesbitt, K., Pinero de Plaza, M. A., Ramos, J. S., Ludlow, M., Nicholls, S. J., Chew, D. P., Beltrame, J., & Clark, R. A. (2024). Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021). Heart Lung and Circulation, 33(7), 1036–1045. https://doi.org/10.1016/j.hlc.2024.01.018

Blumenthal, J. A., & Rozanski, A. (2023). Exercise as a therapeutic modality for the prevention and treatment of depression. Progress in Cardiovascular Diseases, 77, 50–58. https://doi.org/10.1016/j.pcad.2023.02.008

Bozkurt, B., Ahmad, T., Alexander, K., Baker, W. L., Bosak, K., Breathett, K., Carter, S., Drazner, M. H., Dunlay, S. M., Fonarow, G. C., Greene, S. J., Heidenreich, P., Ho, J. E., Hsich, E., Ibrahim, N. E., Jones, L. M., Khan, S. S., Khazanie, P., Koelling, T., … Ziaeian, B. (2025). HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America. Journal of Cardiac Failure, 31(1), 66–116. https://doi.org/10.1016/j.cardfail.2024.07.001

Bozkurt, B., Fonarow, G. C., Goldberg, L. R., Guglin, M., Josephson, R. A., Forman, D. E., Lin, G., Lindenfeld, J. A., O’Connor, C., Panjrath, G., Piña, I. L., Shah, T., Sinha, S. S., & Wolfel, E. (2021). Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel. Journal of the American College of Cardiology, 77(11), 1454–1469. https://doi.org/10.1016/j.jacc.2021.01.030

Braga, M., Nascimento, H., Pinto, R., Araújo, P., Nunes, A., Rodrigues, J., Araújo, V., Parada-Pereira, F., Maciel, M. J., & Rocha, A. (2021). Cardiac rehabilitation in older patients: Indication or limitation? Revista Portuguesa de Cardiologia (English Edition), 40(1), 13–20. https://doi.org/10.1016/j.repce.2020.04.008

Chong, M. S., Sit, J. W. H., Choi, K. C., Suhaimi, A., & Chair, S. Y. (2023). A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study. Asian Nursing Research, 17(3), 180–190. https://doi.org/10.1016/j.anr.2023.06.004

del Corral, T., Fabero-Garrido, R., Plaza-Manzano, G., Fernández-de-las-Peñas, C., Navarro-Santana, M., & López-de-Uralde-Villanueva, I. (2023). Home-based respiratory muscle training on quality of life and exercise tolerance in long-term post-COVID-19: Randomized controlled trial. Annals of Physical and Rehabilitation Medicine, 66(1). https://doi.org/10.1016/j.rehab.2022.101709

Fabero-Garrido, R., del Corral, T., Angulo-Díaz-Parreño, S., Plaza-Manzano, G., Martín-Casas, P., Cleland, J. A., Fernández-de-las-Peñas, C., & López-de-Uralde-Villanueva, I. (2022). Respiratory muscle training improves exercise tolerance and respiratory muscle function/structure post-stroke at short term: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine, 65(5). https://doi.org/10.1016/j.rehab.2021.101596

Fontes, J. P., Vilela, E. M., Durazzo, A., & Teixeira, M. (2021). Current state of cardiac rehabilitation in Portugal: Results of the 2019 national survey. Revista Portuguesa de Cardiologia, 40(11), 877–887. https://doi.org/10.1016/j.repc.2021.01.013

Ghisi, G. L. de M., Kim, W. S., Cha, S., Aljehani, R., Cruz, M. M. A., Vanderlei, L. C. M., Pepera, G., Liu, X., Xu, Z., Maskhulia, L., Venturini, E., Chuang, H. J., Pereira, D. G., Trevizan, P. F., Kouidi, E., Batalik, L., Ghanbari Firoozabadi, M., Burazor, I., Jiandani, M. P., … Grace, S. L. (2023). Women’s Cardiac Rehabilitation Barriers: Results of the International Council of Cardiovascular Prevention and Rehabilitation’s First Global Assessment. Canadian Journal of Cardiology, 39(11), S375–S383. https://doi.org/10.1016/j.cjca.2023.07.016

Ghisi, G. L. de M., Supervia, M., Turk-Adawi, K., Beleigoli, A., Contractor, A., Mampuya, W. M., & Grace, S. L. (2024). Women-Focused Cardiac Rehabilitation Delivery Around the World and Program Enablers to Support Broader Implementation. CJC Open, 6(2), 425–435. https://doi.org/10.1016/j.cjco.2023.10.008

Grave, C., Gabet, A., Iliou, M. C., Cinaud, A., Tuppin, P., Blacher, J., & Olié, V. (2024). Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age, and social disparities. Archives of Cardiovascular Diseases, 117(4), 234–243. https://doi.org/10.1016/j.acvd.2023.12.008

Gray, R., Indraratna, P., Lovell, N., & Ooi, S. Y. (2022). Digital health technology in the prevention of heart failure and coronary artery disease. Cardiovascular Digital Health Journal, 3(6), S9–S16. https://doi.org/10.1016/j.cvdhj.2022.09.002

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(17), e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012

Helmark, C., Harrison, A., Pedersen, S. S., & Doherty, P. (2022). Systematic screening for anxiety and depression in cardiac rehabilitation – are we there yet? International Journal of Cardiology, 352(January), 65–71. https://doi.org/10.1016/j.ijcard.2022.02.004

Hua, C., Huang, W., Chen, Z., Cao, D., Jia, J., Chen, X., Yang, J., & Zhang, L. (2024). Effects of exercise based cardiac rehabilitation delivery modes on chronic heart failure: a systematic review and network meta-analysis. Scientific Reports, 14(1), 1–8. https://doi.org/10.1038/s41598-024-82608-z

Kaminsky, L. A., German, C., Imboden, M., Ozemek, C., Peterman, J. E., & Brubaker, P. H. (2022). The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease. Progress in Cardiovascular Diseases, 70, 8–15. https://doi.org/10.1016/j.pcad.2021.12.001

Karim, A., Muhammad, T., Shah, I., Khan, J., & Qaisar, R. (2022). A multistrain probiotic reduces sarcopenia by modulating Wnt signaling biomarkers in patients with chronic heart failure. Journal of Cardiology, 80(5), 449–455. https://doi.org/10.1016/j.jjcc.2022.06.006

Khalafi, M., Symonds, M. E., Maleki, A. H., Sakhaei, M. H., Ehsanifar, M., & Rosenkranz, S. K. (2024). Combined versus independent effects of exercise training and intermittent fasting on body composition and cardiometabolic health in adults: a systematic review and meta-analysis. Nutrition Journal, 23(1), 1–15. https://doi.org/10.1186/s12937-023-00909-x

Kikuchi, A., Taniguchi, T., Nakamoto, K., Sera, F., Ohtani, T., Yamada, T., & Sakata, Y. (2021). Feasibility of home-based cardiac rehabilitation using an integrated telerehabilitation platform in elderly patients with heart failure: A pilot study. Journal of Cardiology, 78(1), 66–71. https://doi.org/10.1016/j.jjcc.2021.01.010

Kumar, H. U., Nearing, B. D., Mittal, S., Premchand, R. K., Libbus, I., DiCarlo, L. A., Amurthur, B., KenKnight, B. H., Anand, I. S., & Verrier, R. L. (2023). Autonomic regulation therapy in chronic heart failure with preserved/mildly reduced ejection fraction: ANTHEM-HFpEF study results. International Journal of Cardiology, 381(February), 37–44. https://doi.org/10.1016/j.ijcard.2023.03.030

Malandish, A., Ghadamyari, N., Karimi, A., & Naderi, M. (2022). The role of exercise training on cardiovascular peptides in patients with heart failure: A systematic review and meta-analysis. Current Research in Physiology, 5(April), 270–286. https://doi.org/10.1016/j.crphys.2022.06.004

Molloy, C. D., Long, L., Mordi, I. R., Bridges, C., Sagar, V. A., Davies, E. J., Coats, A. J. S., Dalal, H., Rees, K., Singh, S. J., & Taylor, R. S. (2023). Exercise-based cardiac rehabilitation for adults with heart failure - 2023 Cochrane systematic review and meta-analysis. European Journal of Heart Failure, 25(12), 2263–2273. https://doi.org/10.1002/ejhf.3046

Osuji, E., Prior, P. L., Suskin, N., Frisbee, J. C., & Frisbee, S. J. (2022). The relationship between anxiety sensitivity and clinical outcomes in cardiac rehabilitation: A scoping review. American Journal of Preventive Cardiology, 12(August), 100376. https://doi.org/10.1016/j.ajpc.2022.100376

Owen, O., & O’Carroll, V. (2024). The effectiveness of cardiac telerehabilitation in comparison to centre-based cardiac rehabilitation programmes: A literature review. Journal of Telemedicine and Telecare, 30(4), 631–646. https://doi.org/10.1177/1357633X221085865

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n71

Sigamani, A., & Gupta, R. (2022). Revisiting secondary prevention in coronary heart disease. Indian Heart Journal, 74(6), 431–440. https://doi.org/10.1016/j.ihj.2022.11.011

Stefanakis, M., Batalik, L., Antoniou, V., & Pepera, G. (2022). Safety of home-based cardiac rehabilitation: A systematic review. Heart and Lung, 55, 117–126. https://doi.org/10.1016/j.hrtlng.2022.04.016

Taylor, R. S., Dalal, H. M., & Zwisler, A. D. (2023). Cardiac rehabilitation for heart failure: “Cinderella” or evidence-based pillar of care? European Heart Journal, 44(17), 1511–1518. https://doi.org/10.1093/eurheartj/ehad118

Taylor, R. S., Long, L., Mordi, I. R., Madsen, M. T., Davies, E. J., Dalal, H., Rees, K., Singh, S. J., Gluud, C., & Zwisler, A. D. (2019). Exercise-Based Rehabilitation for Heart Failure: Cochrane Systematic Review, Meta-Analysis, and Trial Sequential Analysis. JACC: Heart Failure, 7(8), 691–705. https://doi.org/10.1016/j.jchf.2019.04.023

Terada, T., Cotie, L. M., Tulloch, H., Mistura, M., Vidal-Almela, S., O’Neill, C. D., Reid, R. D., Pipe, A., & Reed, J. L. (2022). Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial. Canadian Journal of Cardiology, 38(8), 1235–1243. https://doi.org/10.1016/j.cjca.2022.03.017

Tognola, C., Bernasconi, D., Myriam Intravaia, R. C., Brioschi, G., Toscani, G., Algeri, M., Shkodra, A., Inglese, E., Sciumè, L., Danesi, R., Beretta, G., Giannattasio, C., & Maloberti, A. (2025). Prevalence of hypertriglyceridemia and its association with extreme cardiovascular risk in patients with acute and chronic coronary syndrome enrolled in a cardiac rehabilitation program. International Journal of Cardiology, 439(March). https://doi.org/10.1016/j.ijcard.2025.133608

Verdicchio, C., Freene, N., Hollings, M., Maiorana, A., Briffa, T., Gallagher, R., Hendriks, J. M., Abell, B., Brown, A., Colquhoun, D., Howden, E., Hansen, D., Reading, S., & Redfern, J. (2023). A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement. Heart Lung and Circulation, 32(9), 1035–1048. https://doi.org/10.1016/j.hlc.2023.06.854

Wang, K., Tian, J., Zheng, C., Yang, H., Ren, J., Liu, Y., Han, Q., & Zhang, Y. (2021). Interpretable prediction of 3-year all-cause mortality in patients with heart failure caused by coronary heart disease based on machine learning and SHAP. Computers in Biology and Medicine, 137, 104813. https://doi.org/10.1016/j.compbiomed.2021.104813

Zahedi, M., & Shirmohammadi, M. (2022). The effect of cardiac rehabilitation on left and right ventricular function in post primary PCI patients. Annals of Medicine and Surgery, 79(July), 104093. https://doi.org/10.1016/j.amsu.2022.104093

Zhou, H., Huang, Y., Zhang, W., Yao, H., Yi, Z., & Li, D. (2025). Trends and advances in cardiac rehabilitation for congenital heart disease: a bibliometric analysis. Journal of Cardiothoracic Surgery, 20(1). https://doi.org/10.1186/s13019-025-03562-z




DOI: https://doi.org/10.33024/mahesa.v6i5.23103

Refbacks

  • Saat ini tidak ada refbacks.


Publisher: Universitas Malahayati Lampung


Creative Commons License
Semua artikel dapat digunakan dibawah lisensi Creative Commons Attribution-ShareAlike 4.0 International License