Exercise for Patients With Heart Failure in Primary Care: the EFICAR

Inclusion Criteria:

• Age ≥ 18 years.
• Diagnosis of HF on the basis of signs and symptoms (Framingham criteria) and evidence of structural heart alterations detected by echocardiography (Echo). Echo scanning guarantees that we are dealing with patients suffering from HF avoiding confounding clinical factors.
• Left ventricle ejection fraction < 45%.
• NYHA functional class II-IV, or Stages B and C of the American Heart Association, in a stable situation for at least the previous four weeks, with no changes in baseline functional status, no signs of congestion or changes in weight faster than 2 kg in three days.
• Receiving optimal treatment with angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARA-II), beta blockers, diuretics, and aldosterone antagonists at stable doses for the previous four weeks, as long as there are no justified contraindications for their use, and meeting the clinical practice guidelines of the European Society of Cardiology [1].
• Anticoagulated patients without atrial fibrillation, ejection fraction < 30%, presence of intracardiac thrombi, or history of embolism.
• In cases of sinusal rhythm or atrial fibrillation, ventricular response is under control both at rest and during exercise (90 beats/minute at rest, and 130 beats/minute during moderate exercise).
• Absence of arrhythmia in exercise stress test that would contraindicate exercise.
• Able to attend an exercise programme and travel to the reference laboratory.
• Informed consent confirmed in writing.

Exclusion Criteria:

• Physical and mental comorbidity which prevents undertaking the exercise programme.
• Major cardiovascular events (in the previous 6 weeks) or cardiovascular procedures, including cardiac resynchronization or implantation of a defibrillator.
• Heart failure pending intervention (mitral valve replacement/repair, ventricular reconstruction, pacemaker/ resynchronization pacemaker, implantable defibrillator, transplant), given that the procedures greatly change the baseline functional status and the prognosis of the disease.
• Heart failure secondary to congenital heart disease or hypertrophic obstructive cardiomyopathy, given that there is a formal contraindication for exercise in such clinical situations.
• Carrier of a fixed-rate pacemaker.
• Exercise test that contraindicates exercise for safety reasons, especially in the case of exercise-induced arrhythmia.
• Poor cognitive state, depression or psychiatric disorder that prevent adherence to an exercise programme.
• Inability to travelling to the health centre by their own means.