Heart Failure: Implications for Diagnosis, Medical Management and Rehabilitation, 3rd Edition

Course Description

Course Description:

Heart failure is an expensive health condition both internationally and within the United States (US). According to the most recent data from 2016,  6.9 million Americans have heart failure, with hospitalizations for this condition having tripled between 1979 and 2004 (Urbich et al., 2020; Ziaeian & Fonarow, 2016). Comorbidities such as iron deficiency, anemia, diabetes mellitus, renal failure, respiratory illness, and depression accompany chronic heart failure contributing to a decline in functional abilities and quality of life (Comín-Colet et al., 2020). Almost one in four heart failure patients are readmitted to the hospital within 30 days, and nearly half are readmitted within six months after discharge. Furthermore, approximately one-quarter of readmissions may be preventable (Kahn et al., 2021).  Data specific to both Europe and the US suggest that there has been a plateau or decrease in the incidence of heart failure because of medical therapies (Bahrami et al., 2008; Djousse et al., 2009; GBD 2013, Mortality and Causes of Death Collaborators, 2015; Ziaeian & Fonarow, 2016). However, these data are suspect to validity as inadequate numbers of non-white and/or female persons are represented in the literature, and there is a lack of quality data from underdeveloped nations (Bahrami et al., 2008; Djousse et al., 2009; GBD, 2013; Gerber et al., 2015; Jin et al., 2020; Mortality and Causes of Death Collaborators, 2015; Ortega et al., 2019; Ziaeian & Fonarow, 2016). Furthermore, the aging of the population will contribute to an increased prevalence of heart failure (Virani et al., 2021). There has been a decline in the number of individuals admitted with a primary diagnosis of heart failure, suggesting better medical management; however, the number of individuals admitted with heart failure remains the primary cause of hospital admission (1% to 2%) in the United States and Europe combined (Akintoye et al., 2017; Blecker et al., 2013; Comín-Colet et al., 2020; Krishnamurthi et al., 2018; Lahoz et al., 2020). Despite the high hospitalization and readmission rates of persons with heart failure, the hospital length of stay has decreased by 1.1 days from 1999 to 2011 (Krumholz et al., 2014; Ziaeian & Fonarow, 2016). This data suggests that persons with heart failure are being seen by practitioners across the continuum of health care and managed in a shorter length of time. 

Recently, the financial burden of heart failure in the United States was estimated at $43.6 billion in both direct and indirect costs in 2020, and it is expected to rise to $69.7 billion by 2030 with most costs related to hospitalizations (Urbich et al., 2020; Ziaeian & Fonarow, 2016). During this same time, total costs, including indirect costs such as lost productivity from early death and functional limitation, are expected to rise 127% from $30.7 billion to $69.7 billion (Urbich et al., 2020; Ziaeian & Fonarow, 2016). Given these costs and recent advances in the medical and surgical management of patients with heart failure, healthcare providers need a firm understanding of both the medical and rehabilitation interventions available to optimize the quality of life for this growing patient population and to work as part of multidisciplinary teams to reduce length of stay and readmissions. 

Guidelines for the management of persons with heart failure, including recommendations for exercise and therapy as part of a multidisciplinary model, are continually evolving and were most recently revised in 2013 (with updates in 2016 and 2017; Ponikowski et al., 2016; Yancy et al., 2017). Given the strong evidence showing that interventions within the scope of practice of most rehabilitative therapists can improve the quality of life of persons with heart failure, there is a growing need for rehabilitative therapists to be directly involved in the management of persons with heart failure (Chandra & Suplicki, 2020). Although aspects of cardiopulmonary examination and interventions are distinctly outlined as requirements to be taught in physical therapy programs in the United States (Commission on Accreditation in Physical Therapy Education [CAPTE], 2020,) there is not specific language within the accreditation standards for occupational therapy educational programs to teach evaluation and intervention approaches specific to cardiovascular and pulmonary health conditions (Accreditation Council for Occupational Therapy Education [ACOTE], 2018).  However, the cardiovascular system is identified as an essential body function in the Occupational Therapy Practice Framework, Fourth Edition (OTPF) and cardiovascular exercise is listed as a physical activity inherent in the occupation of health management (American Occupational Therapy Association [AOTA], 2020a).  As heart conditions continue to represent a significant portion of hospitalizations or morbidity outside of the hospital, rehabilitation professionals, such as occupational therapy practitioners, should continue to seek out knowledge to treat this patient population more effectively. This course reviews the current data on heart failure and presents the current best evidence for clinical practice in managing persons with heart failure.