Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2021; 13(7): 183-203
Published online Jul 26, 2021. doi: 10.4330/wjc.v13.i7.183
Current concept in the diagnosis, treatment and rehabilitation of patients with congestive heart failure
Ivana Sopek Merkaš, Ana Marija Slišković, Nenad Lakušić
Ivana Sopek Merkaš, Nenad Lakušić, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
Ana Marija Slišković, Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Nenad Lakušić, Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
Nenad Lakušić, Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osijek 31000, Croatia
Author contributions: Sopek Merkaš I and Slišković AM were responsible for the conception and design of the manuscript and they wrote the first original draft; Lakušić N contributed to the design of the manuscript and in making critical revisions related to the important intellectual content of the manuscript.
Conflict-of-interest statement: The authors declare that there are no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ivana Sopek Merkaš, MD, Doctor, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Gajeva 2, Krapinske Toplice 49217, Croatia.
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: May 13, 2021
Revised: May 20, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: July 26, 2021

Heart failure (HF) is a major public health problem with a prevalence of 1%-2% in developed countries. The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs. HF is classified according to left ventricular ejection fraction (LVEF) and falls into three groups: LVEF ≥ 50% - HF with preserved ejection fraction (HFpEF), LVEF < 40% - HF with reduced ejection fraction (HFrEF), LVEF 40%-49% - HF with mid-range ejection fraction. Diagnosing HF is primarily a clinical approach and it is based on anamnesis, physical examination, echocardiogram, radiological findings of the heart and lungs and laboratory tests, including a specific markers of HF - brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies. Updated diagnostic algorithms for HFpEF have been recommended (H2FPEF, HFA-PEFF). New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF (e.g., sodium-glucose cotransporter-2 - SGLT2 inhibitors) and such progress in treatment of HFrEF patients resulted in new working definition of the term “HF with recovered left ventricular ejection fraction”. In line with rapid development of HF treatment, cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms, improve exercise capacity and quality of life as well as reduce disability and hospitalization rates. We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.

Keywords: Heart failure, Classification of heart failure, Diagnosis of heart failure, Treatment of heart failure, Cardiac rehabilitation, Heart failure rehabilitation

Core Tip: Diagnostic methods and treatment of heart failure (HF) are evolving rapidly. Making a firm diagnosis of HF with preserved ejection fraction is a challenge, and although diagnostic algorithms have been recommended further research is needed for better classification. Therapeutic options improve morbidity, mortality, as well as functional status of patients with HF with reduced ejection fraction and the new term - HF with recovered left ventricular ejection fraction is a result of successful therapy. Only a small part of patients with chronic HF participates in cardiac rehabilitation programs. Cardiac rehabilitation in patients with HF is an important part of care and should be implemented as a part of holistic approach because it improves exercise capacity and quality of life, reduces disability and hospitalization rates.