What is heart failure rehabilitation?
A heart failure rehabilitation program is medically supervised program designed to help you control your symptoms and resume an active and productive life within the limits of your disease. The program should be adapted to fit your specific needs and goals, and may include a combination of exercise training, nutritional counseling, medication follow-ups, stress management, and careful monitoring of your health.
In most cases heart failure cannot be cured, but can only be managed, so heart failure rehabilitation is a lifetime commitment. A structured rehabilitation program is the best way to get a good start on your heart failure treatment plan, but it will be up to you to stay with it after the program is over. Be sure to read Living with Heart Failure for information on things you can do to ensure you live well after a diagnosis of heart failure.
Heart failure rehabilitation is typically not covered by Medicare, unless you have had a heart attack or a procedure to treat heart disease.1
Who should participate in a heart failure rehabilitation program?
All women with heart failure can benefit from some form of heart failure rehabilitation, tailored to their individual needs. Heart failure rehabilitation is a variation of cardiac rehabilitation, which is used in women with many types of heart disease, including heart attack, chest pain caused by clogged arteries, congenital heart disease, and peripheral artery disease. It is also used in women recovering from a heart procedure such as bypass surgery or angioplasty.
How is heart failure rehabilitation structured?
Programs are designed to fit the individual, so the length of the program can vary from weeks to months, depending on your specific needs. Rehabilitation programs require a doctor's referral and are not typically covered by insurance, except after a procedure or surgery to treat heart disease. Most women with heart failure can safely drive themselves to rehabilitation appointments, but if you have a heart rhythm problem that can cause fainting you may need to find alternate transportation. Talk to your doctor about whether it is safe for your to drive.
If you have had a major procedure or been hospitalized, you will probably begin the program while in the hospital by regaining basic skills, such as getting out of bed and going to the bathroom by yourself. This is known as Phase I cardiac rehabilitation.
After you are discharged from the hospital (or if you have not been hospitalized), you will start the main phase of heart failure rehabilitation. Phase II rehabilitation will include a supervised exercise program designed to build your strength and endurance, usually lasting for 3 months 3 or more times a week. In addition to standard exercise such as a treadmill or walking, some programs may incorpoate nontraditional activities such as dance or other exercise classes. For most women with heart failure, an exercise program can improve heart failure symptoms, ability to perform physical tasks, and quality of life.2 See Exercise Training for Heart Failure for more on the benefits of exercise and what a typical program is like. You will also receive education about your medications, risk factors, and the lifestyle changes necessary to lead an independent and fulfilling life with heart failure.
Phase III of your heart failure rehabilitation begins after your main rehabilitation program is over. You will be given instructions on follow-up appointments and education on how to follow your treatment plan, keep exercising, and make healthy lifestyle changes. Home-health visits and telephone monitoring may also be a part of your long-term plan.
Besides exercise, what else should be included in a heart failure rehabilitation program?
Although a supervised exercise training program is the foundation of heart failure rehabilitation, education and counseling programs are important as well. A team of healthcare professionals including your primary care physician, nurses, dieticians, counselors, social workers, and physical and occupational therapists will help you learn how to manage your heart failure treatments, avoid future heart problems, and care for your own health after the rehabilitation program is over.
Your risk factors will be identified and you will be given advice on how to control them, including strategies to quit smoking and dietary tips to reduce fat, salt, and cholesterol and control your fluid balance. Weight loss is often a goal of cardiac rehabilitation and you will learn about the importance of a heart-healthy diet and how you can incorporate one into your daily life. A rehabilitation program may offer classes or lectures including an introduction to your disease, energy conservation, breathing techniques, and learning to live with your diagnosis. You will also learn about your medications, how to take them, and how to deal with any side effects you may experience.
Counseling programs focus on depression and other issues experienced by women coping with heart problems or following heart surgery, such as getting back to work, new physical limitations, and managing stress. These mental health aspects of rehabilitation are especially important for women, who have more depression and anxiety after a diagnosis of heart failure than men.3
Your rehabilitation program may have an occupational therapy component to assist you in becoming as independent as possible. The term "occupational therapy" refers to the goal of giving you the skills needed for "the job of living." An occupational therapist can help you learn new ways to perform "activities of daily living"—such as getting around, dressing, using the restroom, preparing meals, and managing a household or job. She or he may also recommend modifications to your home to ensure your safety and help you be more independent, and give you advice and instruction on assistive devices that can make your life easier. Click here for more practical tips on making everyday tasks easier while living with heart failure.
What are the benefits of cardiac rehabilitation in women with heart failure?
Participating in a heart failure rehabilitation can have enormous benefits for women with heart failure.4 Compared with women who receive only usual care, women who take part in a rehabilitation program:
- Are more likely to follow through on their treatment plan and take their medications properly5
- Have fewer heart failure symptoms2
- Experience less anxiety and depression6
- Have an easier time performing physical tasks
- Are more likely to exercise
- Are more likely to follow a low-salt diet7
- Have better blood pressure control8
- Have a better quality of life9
These benefits persist even after the program is over. In one study, heart failure patients who participated in a rehabilitation program were doing better even 6 years later.10
What happens after the rehabilitation program is over?
When your rehabilitation program ends, you should know how to continue your treatment and exercise plans on your own at home. Long-term follow up may include home health visits and telephone calls from your healthcare team. You will continue to work with your primary care physician and cardiologist to adjust your medications and follow your treatment plan.
Often women are very enthusiastic during a rehabilitation program, but have trouble keeping up that motivation once it is over. Sometimes it is difficult to continue exercising and following your treatment plan when you no longer have the one-on-one attention and support from health care professionals and other participants. See Living with Heart Failure for tips on how to get organized and stay motivated after a rehabilitation program has ended.
Many women with heart failure are able get exercise by returning to physical activities and hobbies they enjoy. Exercise doesn't need to be performed on a treadmill or stationary bike to have benefits: activities like dancing, gardening, aerobics, and yoga can be enjoyable and give you a workout at the same time. Be sure to talk to your doctor about what level of physical activity is safe for you.
Choosing Rehabilitation Services
Your primary care doctor, cardiologist, and hospital can help you find rehabilitation programs in your area that suit your needs. The best programs bring together doctors, nurses, physical therapists, psychologists, dieticians, and occupational therapists at one facility, or at least through the same organization. They should be willing to design a program to meet your individual needs.
Some questions you should ask when deciding on a rehabilitation program:
- Is the program certified by the American Association of Cardiovascular & Pulmonary Rehabilitation? You can search for certified programs here.
- Who runs the program? Does she or he specialize in rehabilitation for women with heart disease?
- Is the program covered by my insurance? Are there any other fees?
- Do I need a doctor's referral?
- Will you send regular reports to my doctor?
- How is the program organized and who will be involved in my care?
- Does the staff specialize in treating women with heart disease?
- Who supervises the exercise sessions?
- What are the emergency procedures? Does the staff have emergency training?
- Are educational and counseling services available?
- Can my family attend educational and counseling sessions with me?
- Where does the program take place? Is transportation available?
- How long will the program last?
- What happens after I finish the program?
For More Information:
Search for a certified cardiac rehabilitation program
American Association of Cardiovascular & Pulmonary Rehabilitation Patient Resources
American Association of Heart Failure Nurses
American Heart Association – Cardiac Rehabilitation
American Dietetic Association Food and Nutrition Info for Women
Find a Nutrition Professional
American Occupational Therapy Association
National Board for Certification in Occupational Therapy
Cleveland Clinic Heart & Vascular Institute Resources for Patients
Womenheart.org Patient Advocates
- Centers for Medicare and Medicaid Services. Decision memo for cardiac rehabilitation programs (CAG-00089R). Available at: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=164&. Accessed August 17, 2009.
- Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. Apr 14 2009;53(15):e1-e90.
- Gottlieb SS, Khatta M, Friedmann E, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol. May 5 2004;43(9):1542-1549.
- Windham BG, Bennett RG, Gottlieb S. Care management interventions for older patients with congestive heart failure. Am J Manag Care. Jun 2003;9(6):447-459; quiz 460-441.
- Rich MW, Gray DB, Beckham V, Wittenberg C, Luther P. Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med. Sep 1996;101(3):270-276.
- Kulcu DG, Kurtais Y, Tur BS, Gulec S, Seckin B. The effect of cardiac rehabilitation on quality of life, anxiety and depression in patients with congestive heart failure. A randomized controlled trial, short-term results. Eura Medicophys. Dec 2007;43(4):489-497.
- Arcand JA, Brazel S, Joliffe C, et al. Education by a dietitian in patients with heart failure results in improved adherence with a sodium-restricted diet: a randomized trial. Am Heart J. Oct 2005;150(4):716.
- Zwisler AD, Soja AM, Rasmussen S, et al. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J. Jun 2008;155(6):1106-1113.
- Austin J, Williams WR, Ross L, Hutchison S. Five-year follow-up findings from a randomized controlled trial of cardiac rehabilitation for heart failure. Eur J Cardiovasc Prev Rehabil. Apr 2008;15(2):162-167.
- Mueller L, Myers J, Kottman W, et al. Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure. Clin Rehabil. Oct 2007;21(10):923-931.