Chronic Heart Failure and Coronary Artery Disease: Pharmacological Treatment and Cardiac Rehabilitation

Abstract

Coronary artery disease is the leading cause of acute and chronic heart failure. Patients with heart failure and ischemic heart disease need a tailored assessment to define the appropriate treatment, while a specific multidisciplinary management plan should be followed. Indeed, several factors should be assessed before starting treatment, such as heart failure symptoms and/or signs, angina, electrocardiographic features, right and left ventricular systolic and diastolic function, serological abnormalities, cardiac structural and functional integrity, and pulmonary function. New scenarios and developments have emerged recently in this field, increasing our knowledge regarding pathophysiology, exercise, and pharmacology. Effective and appropriate management and treatment reduce the risk of death and hospitalization for heart failure. Herein, we provide an updated, state-of-the-art overview of pharmacological treatment and cardiac rehabilitation in patients with chronic heart failure and coronary artery disease. Furthermore, tailored and contemporary management in clinical practice will be proposed for this specific and fragile patient population.

Keywords: cardiac rehabilitation; chronic heart failure; coronary artery disease; guideline-directed medical therapy; pharmacological treatment.

Figure 1

Diagnostic tests in patients with suspected chronic heart failure. The diagnostic algorithm for a patient with chronic coronary syndrome and suspected chronic heart failure is composed of a twelve-lead electrocardiogram, routine blood test, natriuretic peptide dosage, chest radiography, and transthoracic echocardiography. 12-lead ECG = twelve-lead electrocardiogram; BNP = B-type natriuretic peptide; NT-proBNP = N-terminal pro-B-type natriuretic peptide; X-ray = chest radiography.

Figure 2

Core components of cardiac rehabilitation program in patients with chronic heart failure and coronary artery disease. The cardiac rehabilitation program for patients with chronic heart failure and coronary artery disease has the following components: patient assessment, physical activity counseling, diet and nutritional counseling, patient-centered care and education, exercise training, weight control management, cardiovascular risk factor management, psychosocial management, and medication management.

Figure 3

Management algorithm for patients with chronic heart failure and coronary artery disease: exercise assessment and prescription and cardiac rehabilitation program. AHF—acute heart failure; CPET—cardiopulmonary exercise test; CR—cardiac rehabilitation, ECG—electrocardiogram.