Early Preventive Measures for Heart Failure Systematic Review


Heart failure (HF) is a rising healthcare burden and is the most common hospitalization and readmission source. Avoiding recessions of HF patients is an expanded problem for doctors, researchers, and various stakeholders. The subsequent analysis will analyze the measures reported to decrease patient readmissions and increase quality of hospital services on the 30-day readmission assessment. Although evidence-based HF treatment therapies have proliferated, sustained progress remains the foundation for successfully applying such therapies and designing innovative methods to discourage readmission more effectively.

The growing incidence of chronic heart diseases is an ongoing public health crisis, as stated in 2015. The U.S. annual economic burden is predicted to rise to over 108 billion a year above the population’s age (Scrafford et al., 2019). Unplanned admission to hospitals is a primary cost factor for heart failure (HF). Patients face a significant risk of exercise intolerance and reduced quality of life related to fitness, mortality, increased hospital admission, and higher costs (Lyons et al., 2018). The emphasis on quality of life is evolving increasingly with significant mortality changes over the last decade through patients’ psychotherapy and heart failure with reduced ejection fraction (HFrEF).

The patients with a diminished expulsion fraction, known as a lower expulsion fraction (LEF) and a lower HF fraction (more than 45-5%), are classified into two primary subcategories: HF with more destitute left ventricular contraction and patients with impaired left ventricular contraction (Healthwise Staff, 2019). Epidemiological statistics indicate that nearly half of all HF patients have heart failure with preserved ejection fraction (HFpEF) (Dunlay et al., 2017). This patient subgroup has not been recruited by more modern drug and medical device therapies. While drug therapy and system care have led to the enhancement of HFrEF results, the prognosis of HFpEF remains relatively unchanged. No extensive randomized trials have shown treatment advantages that improve or lower mortality in HFpEF’s ordinary course.

The British Cardiovascular Preventive and Rehabilitation Association (BACPR) defines cardiac rehabilitation as a “coordinated total of the interventions required for the favorable effect on the underlying factors, physical, emotional and social problems and the maintenance of or re-establishment of optimum function by the patients, through their efforts (The British Cardiovascular Preventive and Rehabilitation Association [BACPR], 2017, 1). The definition emphasizes that while preparation is essential, rehabilitation services should be comprehensive and provide lifestyle, risk factor, risk factor management education, and guidance and therapeutic support. While drug therapy and system care have led to the enhancement of HFrEF results, the prognosis of HFpEF remains relatively unchanged. No extensive randomized trials have shown treatment advantages that improve or lower mortality in HFpEF’s ordinary course.

Based on current clinical practice, international recommendations on cardiac treatment include those from the American Cardiology Association, the European Cardiology Society, and the National Centre for Health Excellence in the UK. However, the actual cardiology exercise-based cardiac rehabilitation (CR) uptake, which is still not optimal, with less than 20% of heart failure rehabilitation, has been identified in research in the United States and Europe (Bjarnason-Wehrens et al., 2019). Alternative models to focused cardiac rehabilitation, including home-based and technical provisions, have increased heart failure connectivity and cardiac rehabilitation utilization.

How does the Presence of Exercise Work?

A variety of pathways would cause HF patients to benefit from operations. First, preparation increases myocardial infusion by relieving endothelial dysfunction, disseminating coronary vessels, and stimulating new vessel growth through intermittent ischemia for people with an ischemic trigger HF (Giannitsi et al., 2019). Moreira et al. (2020) have shown aerobic activity to enhance contractility and diastolic filling in the myocardial. Furthermore, D’Andrea and his associate meta-analysis demonstrate the effects of planning for cardiac recovery by calculating excessive ejection fractions, end-diastolic volumes, and volumes. (D’Andrea et al., 2020). HF characterizes, no matter the cause, essential neurohormonal and musculoskeletal anomalies. Management can reduce adrenergic sound and strengthen the vagal tone, as seen in a heart variability test. Dysfunction and waste of skeletal muscle may also be a reaction to workouts (Vadana, 2019). Regular physical exercise has proved to induce skeletal muscle vasodilation for people with HF.

Most patients with heart conditions die within five years of admission despite the enhancement of care over the past years. The survival rate of individuals with heart failure remains low, and the survival rates are worse than breast or prostate cancer patients. Hence, this research problem on heart failure aims to educate patients on early prevention and management of chronic heart conditions and educate more people on underlying heart conditions, promoting healthy lifestyles.

Objective and Intention of the Research

To assess the mortality, entry, and well-being of individuals with heart disease outcomes from cardiac therapy based on exercise.

Search Methods

The Cochrane Central Test Register (CENTRAL), MEDLINE, Embase, and three other databases were retrieved by the researchers in 2020. The researcher also reviewed systematic analysis bibliographies and two evaluation registers.

Selection Principles

Randomized controlled tests compared exercise-based heart recovery treatments to six months or more versus no control activity that may provide routine healthcare were used. Adults (>18 years) with HF data – either HFrEF or HFpEF were included in the sample population.

Data Collection Technique and Analysis

Both known and unknown sources were screened separately by two authors, and those explicitly unable to be included in the analysis were rejected. The investigator collected full papers of possible related experiments. Two independent study authors collected data from the included tests and calculated their probability for bias, and analyzed the grades.

Criteria for the Review of Studies

The research included randomized controlled trials (RCTs), conducted at least six months after the randomization, in a parallel or cross-over design. The researcher has selected this follow-up to reflect improved results and emphasis by policymakers.

Study Population

People between 18 to 65 years old with HF were involved in the analysis. Studies focusing on participants who earned exercise-based CR have been omitted by the researcher because prior participant intervention exposures can distort studies’ perceptions. However, the researcher used the trial sample mostly of new patients with CR who had HF primarily.

Type of Interventions

In addition to exercise measures, the study covered fitness approaches alone or in systemic cardiac recovery as services with elements such as physical education and psychological interventions. The investigating party is not eligible but could have succeeded (i.e., college, psychiatric surgery) or considered a medical care requirement.

Outcome Measures

To be considered, one or more findings of the analysis must have been analyzed. Two occasions, up to 12 months of (short-term) follow-up and over 12 (long-term) months (long-term) reporting, are obtained by the researchers. Every time point review to determine medication outcomes included the most extended follow-up.

Selection of Studies

Two study authors (D1 & W3) separately screened and discontinued irrelevant research associated with the quest technique by analyzing titles and abstracts. In choosing abstracts, it was necessary, as stated, to identify the architecture of the survey, the appropriate population, and the related intervening components. In compliance with the inclusion criteria, a reader obtained the complete text reports for all possibly relevant studies and independently checked them for two (D1 and W3) reviewer eligibility. By talking to a third review author, we settled differences in rhetorical structure theory (RST). In previous review iterations, RST undertook data analysis collection. To complete the PRISMA flow map, we reported the selection process in enough detail.

PRISMA flow map


Inclusion of Cardiac Failure Cases with Retained Expulsion

Based on research parameters, only one study was performed in patients with HFpEF only, and 17 other trials were involved and recorded the number of patients with HFpEF. If studies indicate that patients with HFpEF were concerned, the authors had been approached without reporting percentage or number. The proportions of HFpEF patients ranged from 18% to 100% and were varied in trials. No trials have been performed to classify HFPEF, by the current ESC, with the following criteria: symptoms and signs of HF left ventricular Ejection Fraction in 50%, elevated natural peptide level left ventricle or left atrial enlarged or diastolic instability of the echocardiograms. Five trials had mostly heart failure patients (64-84%), but only one solved cardiology-specific issues.

Table 1: HF detection in selected trials

Study Nation Study Size Patient with Heart Failure Relevant Findings for Heart Failure
Kwok et al. (2008) China 105 Hospitalization appointed for Heart Failure No
Jaarsma et al. (2008) Netherlands 1023 Recruited for Heart Failure signs and the effects after hospital admission, plus evidence of structural cardiovascular disease No
Brotons et al. (2009) Spain 283 Admitted to the hospital with Heart Failure confirmed primary or secondary diagnosis No
Andryukhin et al. (2010) Russia 100 Ejection Fraction ≤ 60 percent and Echo proof of Heart Failure, left ventricle stiffness, or irregular Left Ventricle relief included in patients with signs and symptoms Yes
Leventhal et al. (2011) Switzerland 42 Recruited for decompensated Heart Failure dependent on hospital admission No
Srisuk et al. (2015) Thailand 100 MD confirmed primary dx Heart Failure with empirical proof by Echo if necessary No
Tsuchihashi-Makaya et al. (2013) Japan 168 Enlisted from 3 cardiology clinics No
Stewart et al. (2014) Australia 280 Heart specialist established dx Heart Failure Yes, no
Gonzalez-Guerrero et al. (2015) Spain 117 Hospitalized in one single center of acute Heart Failure (European Society of Cardiology criteria) No
Bekelman et al. (2015) USA 392 Heart Failure diagnosis for emergency or ambulatory patients of some kind No
Dracup et al. (2014) USA 602 Hospitalization needed to be recruited from clinics and hospitals within six months Added as a covariant Heart Failure community (by Ejection Fraction < 60% or ≤50% or 0,5%); no distinction between Heart Failure with Preserved Ejection Fraction
and HFrEF
Freedland et al. (2015) USA 158 In the last three months, dx with Heart Failure is selected from the single health clinic No
Chang et al. (2016) Taiwan 84 Cardiology ambulatory recruited dx Heart Failure confirmed with cardiology No
Masterson Creber et al. (2016) USA 100 Recruited in 1 metropolitan hospital during Heart Failure hospital treatment No
Young et al. (2016) USA 100 Admitted to hospital for Heart Failure No
Kalter-Leibovici et al. (2017) Israel 1360 Dx based on signs and symptoms echo data recruited from public hospitals, conventional and volunteer cardiologists in 2 months following Heart Failure; Yes, lower Disease Management Programme impact and considerable Confidence Interval for Heart Failure with Preserved Ejection Fraction
than HFrEF; no significant difference in composite outcomes, Heart Failure, or All-cause mortality
Bekelman et al. (2018) USA 314 Symptomatic Heart Failure ambulator used dx + medication, Ejection Fraction and Brain natriuretic peptide details The Kansas City Cardiomyopathy Questionnaire response effect varies from Ejection Fraction
with lower Heart Failure with Preserved Ejection Fraction interference effect

Definition of Cardiac Insufficiency with Retained Expulsion

The cut-off points for the Ejection Fraction Heart Failure concept ranged between 0.40% and0.50%. Only seven reports are associated with the suggested ESC exemption EF<50% (Brotons et al. (2009), Andryukhin et al. (2010), Bekelman et al. (2015), Chang et al. (2016), Young et al. (2016), and Kalter-Leibovici et al. (2017). Three trials, González-Guerrero et al. (2015), Masterson Creber et al. (2016), and Srisuk et al. (2015), involved HFpEF labeled but not specified patients with HFpEF. For HFpEF-differentiated patients, the remaining nine clinical trials used EF criteria +45 percent, 27-29 or 40%. The number of patients found in Heart Failure studies in Retained Ejection Fraction varied from 22 to 77%. According to the European Service of Treatment criteria, all of the patients taken into account by the guidelines of two distinct clinical bodies are HF of the midrange ejection fraction (HFrEF, 40-49 percent ejection fraction).

The Impact on Hospital Admissions of Disease Management Programs

The most frequent experiments were all-induced (n=8), the cardiac problem only (n=5), all-induced and all-induced (n=2), or circulatory (n=1), with most outcomes measurements used for the treatment of patient admissions. Hospitalizations were the most systematic research (n=8). Most experiments have demonstrated either a non-impact-friendly trend for intervention, for example, short-stay hospitalization and long-stay hospitals and fewer overall hospitalization (Kalter-Leibovici et al., 2017; Jaarsma et al., 2009), or higher-hop trends (Andryukhin et al., 2010).

The Effects on Self-Care of Disease Control Programs

Nine reports have measured the effects of the self-care intervention. Essential variations in self-care outcomes are observed in the staff: The heart disease index was the most widely used (n = 5) in four of the self-care effect studies (n=9), Srisuk et al. (2015). Moreover, Young et al. (2016) recorded two changes that reported substantial improvements; self-care results were reported (n=5) respectively. Self-care results assessments were reported, respectively.


Automatic intervention to minimize the risk of heart defect-referred endpoint hospital admission alone and a slight increase in HRQoL relative to standard treatment was previously reported. Both types of research contained instructional elements, actions, or self-help to improve self-management in this study. There have been statistical changes to self-care in just three of 9 self-care trials. This finding can be explained by program characteristics, effect mechanisms, and efficacy evidence. There have been no consistent app features consistently providing a positive effect on the individual patient meta-analysis of 20 self-management assistance trials in heart failures (n=5624). A comprehensive 2016 analysis and a practical overview of the critical HF DMP pathways showed that successful programs could incorporate components in enhancing patients’ comprehension of HF, self-treatment, the involvement of family and caregiver, psychosocial stability, clinical care, and use of technology (Clark et al., 2016). Finally, the study was limited knowledge of optimal behaviors in life and self-care in HFpEF, and there is little evidence of the efficacy of self-care interventions for HFpEF.

The majority of the studies advocated being physically active, but only one study conducted a workout. Other research promoted self-management, preparation, structured exercise plans (even if not noted), and assessed one operation, mainly as part of a self-management intervention led by mobile. In both classes, no identifiable difference was found in the behavior. Exercise in patients with HFpEF is successful but underused. Although the data are limiting, a six-study meta-analysis (n=276 patients) revealed that exercise significantly improves cardio-aspiratory fitness and quality of life about control (Enyikwola et al., 2017). There were no reports of clinical findings and short-term studies (12-24 weeks).

A small study tested the effect on 100 patients with obese HFPEF, including calorie diets, aerobic workout, a diet and exercise combination, and therapy. The food, health and nutrition, and exercise classes were vastly increased at 24 Weeks. However, the quality of life measured by the MLHFQ was not substantially modified by peak VO2 (the most significant improvement in diet and training) (Schmidt et al., 2018). Diet substantially strengthened KKQC and diet, and exercise in the New York Heart dramatically reduced body mass and enhanced grades.

Limitation of Study

There are several drawbacks to this systemic analysis. Significantly, the differing and contradictory concept of HFpEF (some HFpEF samples), the heterogeneity and variance of research goals, treatments, calculated effects, condition evaluation, and the percentage of HFpEF patients restricted our ability to compare trials, use meta-analysis and draw specific results specifically. The proportion of HFpEF patients surpassed 50 percent in just six tests, although only four studies showed different HFpEF patients’ outcomes. The search technique could not have given satisfactory results because gray literature and articles were not included in languages other than Greek or English. Term limits were applied, and not all available data sets were scanned. The study team and participants who could support the intervention group cannot be blinded in DMPs. Particular consideration should be paid to interpreting the outcomes from the current study and conclusions given the lack of evidence for properly defined HFpEF.


An important constraint in evaluating results, which do not indicate the impact of DMPs on patients, is a variable description of the HFpEF (including patients) used in the research. Evidence is insufficient to render substantive assumptions, but in terms of mortality, frequency of hospitalization, self-treatment, FR-knots, quality of life, fear, sleep, statistically related or positive trends were found. This study shows that HF patients require not only drugs managed by physicians and staff but also proper education to boost everyday self-care. Consequently, physical regular exercises and cardiology exercise-based cardiac rehabilitation (CR) provide an educational possibility of early preventive measures and prevent readmission and noncompliance with chronic management.


Andryukhin, A., Frolova, E., Vaes, B., & Degryse, J. (2010). The impact of a nurse-led care program on events and physical and psychosocial parameters in patients with heart failure with preserved ejection fraction: A randomized clinical trial in primary care in Russia. European Journal of General Practice, 16(4), 205-214. Web.

Bekelman, D. B., Allen, L. A., McBryde, C. F., Hattler, B., Fairclough, D. L., Havranek, E. P., Turvey, C., & Meek, P. M. (2018). Effect of a collaborative care intervention vs. usual care on patients’ health status with chronic heart failure. JAMA Internal Medicine, 178(4), 511. Web.

Bekelman, D. B., Plomondon, M. E., Carey, E. P., Sullivan, M. D., Nelson, K. M., Hattler, B., McBryde, C. F., Lehmann, K. G., Gianola, K., Heidenreich, P. A., & Rumsfeld, J. S. (2015). Primary results of the patient-centered disease management (PCDM) for heart failure study. JAMA Internal Medicine, 175(5), 725. Web.

Bjarnason-Wehrens, B., Nebel, R., Jensen, K., Hackbusch, M., Grilli, M., Gielen, S., Schwaab, B., & Rauch, B. (2019). Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The cardiac rehabilitation outcome study in heart failure (CROS-HF): A systematic review and meta-analysis. European Journal of Preventive Cardiology, 27(9), 929-952. Web.

The British Cardiovascular Preventive and Rehabilitation Association. (2017). The BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation 2017 (3rd ed.). The British Association for Cardiovascular Society.

Brotons, C., Falces, C., Alegre, J., Ballarín, E., Casanovas, J., Catà, T., Martínez, M., Moral, I., Ortiz, J., Pérez, E., Rayó, E., Recio, J., Roig, E., & Vidal, X. (2009). Randomized clinical trial of the effectiveness of a home-based intervention in patients with heart failure: The IC-DOM study. Revista Española de Cardiología (English Edition), 62(4), 400-408. Web.

Chang, Y., Chiou, A., Cheng, S., & Lin, K. (2016). Tailored educational, supportive care program on sleep quality and psychological distress in heart failure patients: A randomized controlled trial. International Journal of Nursing Studies, 61, 219-229. Web.

Clark, A. M., Wiens, K. S., Banner, D., Kryworuchko, J., Thirsk, L., McLean, L., & Currie, K. (2016). A systematic review of the main mechanisms of heart failure disease management interventions. Heart, 102(9), 707-711. Web.

Dracup, K., Moser, D. K., Pelter, M. M., Nesbitt, T. S., Southard, J., Paul, S. M., Robinson, S., & Cooper, L. S. (2014). A randomized, controlled trial to improve self-care in patients with heart failure living in rural areas. Circulation, 130(3), 256-264. Web.

Dunlay, S. M., Rogers, V. L., & Redfield, M. M. (2017). Epidemiology of heart failure with preserved ejection fraction. Nature Review Cardiology, 14(2017), 591–602. Web.

D’Andrea, A., Sperlongano, S., Pacileo, M., Venturini, E., Iannuzzo, G., Gentile, M., Sperlongano, R., Vitale, G., Maglione, M., Cice, G., Maria Sarullo, F., Di Lorenzo, A., Vigorito, C., Giallauria, F., & Picano, E. (2020). New ultrasound technologies for ischemic heart disease assessment and monitoring in cardiac rehabilitation. Journal of Clinical Medicine, 9(10), 3131. Web.

Enyikwola, R., Musa, B., & Ekwo, A. (2017). An appraisal of the physical fitness status of security personnel in the University of JOS: Implication for safety health enhancement. International Journal of Educational Benchmark (IJEB), 7(7), 69-79.

Freedland, K. E., Carney, R. M., Rich, M. W., Steinmeyer, B. C., & Rubin, E. H. (2015). Cognitive behavior therapy for depression and self-care in heart failure patients. JAMA Internal Medicine, 175(11), 1773. Web.

Giannitsi, S., Maria, B., Bechlioulis, A., & Naka, K. (2019). Endothelial dysfunction and heart failure: A review of the existing bibliography with emphasis on flow-mediated dilation. JRSM Cardiovascular Disease, 8, 204800401984304. Web.

González-Guerrero, J. L., Alonso-Fernández, T., García-Mayolín, N., Gusi, N., & Ribera-Casado, J. M. (2015). Effect of a follow-up program in elderly adults with heart failure with cognitive impairment after hospital discharge. Journal of the American Geriatrics Society, 63(9), 1950-1951. Web.

Healthwise Staff. (2019, December 15). Health library. University of Michigan | Michigan Medicine. Web.

Jaarsma, A. D., De Grave, W. S., Muijtjens, A. M., Scherpbier, A. J., & Van Beukelen, P. (2008). Perceptions of learning as a function of seminar group factors. Medical Education, 42(12), 1178-1184. Web.

Kalter-Leibovici, O., Freimark, D., Freedman, L. S., Kaufman, G., Ziv, A., Murad, H., Benderly, M., Silverman, B. G., Friedman, N., Cukierman-Yaffe, T., Asher, E., Grupper, A., Goldman, D., Amitai, M., Matetzky, S., Shani, M., & Silber, H. (2017). Disease management in the treatment of patients with chronic heart failure who have universal access to health care: a randomized controlled trial. BMC Medicine, 15(1). Web.

Kwok, T., Lum, C. M., Chan, H. S., Ma, H. M., Lee, D., & Woo, J. (2008). A randomized, controlled trial of an intensive community nurse – supported discharge program prevents hospital readmissions of older patients with chronic lung disease. Journal of the American Geriatrics Society, 52(8), 1240-1246. Web.

Leventhal, M., Denhaerynck, K., Brunner-La Rocca, H., Burnand, B., Conca-Zeller, A., Bernasconi, A., Mahrer-Imhof, R., Sivarajan Froelicher, E., & De Geest, S. (2011). Swiss interdisciplinary management program for heart failure (SWIM-HF): A randomized controlled trial study of an outpatient inter-professional management program for heart failure patients in Switzerland. Swiss Medical Weekly. Web.

Lyons, K., Auld, J., Mudd, J. O., Gelow M., Hiatt, S. O., Chien, C. V., & Lee, C. S. (2018). EuroHeartCare 2018. European Journal of Cardiovascular Nursing, 17(1_suppl), S1-S120. Web.

Masterson Creber, R., Patey, M., Lee, C. S., Kuan, A., Jurgens, C., & Riegel, B. (2016). Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial. Patient Education and Counseling, 99(2), 256-264. Web.

Moreira, J. B., Wohlwend, M., & Wisløff, U. (2020). Exercise and cardiac health: Physiological and molecular insights. Nature Metabolism, 2(9), 829-839. Web.

Schmidt, T., Bjarnason-Wehrens, B., Mommertz, S., Schulte-Eistrup, S., Willemsen, D., Sindermann, J., Predel, H., & Reiss, N. (2018). Development of exercise-related values in heart failure patients supported with a left ventricular assist device. The International Journal of Artificial Organs, 42(4), 201-206. Web.

Scrafford, C. G., Bi, X., Multani, J. K., Murphy, M. M., Schmier, J. K., & Barraj, L. M. (2019). Health economic evaluation modeling shows potential health care cost savings with increased conformance with healthy dietary patterns among adults in the United States. Journal of the Academy of Nutrition and Dietetics, 119(4), 599-616. Web.

Srisuk, N., Cameron, J., Ski, C. F., & Thompson, D. R. (2015). A randomized controlled trial of family-based education for patients with heart failure and their carers. Journal of Advanced Nursing, 73(4), 857-870. Web.

Stewart, S., Carrington, M. J., Horowitz, J. D., Marwick, T. H., Newton, P. J., Davidson, P. M., Macdonald, P., Thompson, D. R., Chan, Y., Krum, H., Reid, C., & Scuffham, P. A. (2014). Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort. International Journal of Cardiology, 174(3), 600-610. Web.

Tsuchihashi-Makaya, M., Matsuo, H., Kakinoki, S., Takechi, S., Kinugawa, S., & Tsutsui, H. (2013). Home-based disease management program to improve psychological status in patients with heart failure in Japan. Circulation Journal, 77(4), 926-933. Web.

Vadana S. (2019). A Study of Heart Rate Variability and Serum Adiponectin in Women with Polycystic Ovary Syndrome [Unpublished doctoral dissertation]. The Tamil Nadu Dr. M.G.R. Medical University.

Young, L., Hertzog, M., & Barnason, S. (2016). Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: The PATCH randomized controlled trial. BMC Cardiovascular Disorders, 16(1). Web.