Table 7 Non-pharmacological interventions recommended by the included CPGs for of HF
Prevention & management | Recommended self-managed non-pharmacological interventions | COR/LOE | Grading system used | Guidelines |
|---|---|---|---|---|
Prevention of HF | Embracing a wholesome way of living, which includes consistent PA, keeping a balanced weight, practicing nutritious eating habits, and abstaining from smoking, can lower the potential likelihood of heart failure among the broader populace in the times to come. | 1/B-NR | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ACC/HFSA HF (2022) |
Prevention of HF | PA is recommended for all individuals to minimize the likelihood of developing HF. | Strong/Moderate | GRADE standards | Canadian HF (2017) |
Prevention of HF | Smoking cessation | Strong/Low | GRADE methodology | Australia HF (2018) |
Prevention of HF | Avoiding excess alcohol | Strong/ very low | GRADE methodology | Australia HF (2018) |
Prevention of HF | Weight reduction for overweight or obese patients | Strong/low | GRADE methodology | Australia HF (2018) |
Prevention of HF | Regular PA | Strong/low | GRADE methodology | Australia HF (2018) |
Prevention of HF | Healthy lifestyles | I/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Prevention of HF | Smoking cessation | I/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Prevention of HF | PA Regular exercise Form: Moderate intense activity Duration/Frequency: At least 150 min/week | I/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Prevention of HF | Maintain ideal body weight | I/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Prevention of HF | Reducing alcohol consumption | I/C | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Prevention of HF | General lifestyle modifications via weight reduction and enhanced PA. | I/A, A/I | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Prevention of HF | Smoking cessation | I/C, B/Ivb | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Prevention of HF | Control alcohol consumption | IIa/C, C1/VI | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Prevention of HF | PA and exercise habits | I/B, B/Iva | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Management of HF | ||||
Diet and nutrition, fluid restriction | Well- balanced diet, avoid adding salt or flavoring sauces. | IIa/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Diet and nutrition, fluid restriction | Individualized fluid intake, 1–1.5 L/day for patients with normal renal function. | IIa/C | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Diet and nutrition, fluid restriction | Avoiding excessive sodium intake for stage C HF patients. | 2a/C-LD | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ACC/HFSA HF (2022) |
Diet and nutrition, fluid restriction | Fluid restriction: uncertain benefit for patients with advanced HF and hyponatremia. | 2b/C-LD | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ACC/HFSA HF (2022) |
Diet and nutrition, fluid restriction | Low-salt diet (< 6 g/day) | IIa/C, C1/VI | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Diet and nutrition, fluid restriction | Restriction of alcohol (Moderate in drinking) | IIa/C, C1/VI | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Diet and nutrition, fluid restriction | Restrict dietary salt intake to 2-3 g/day | Weak/Low | GRADE standards | Canadian HF (2017) |
Diet and nutrition, fluid restriction | Limiting fluid intake to 2 L/day for patients with fluid retention or congestion that is not effectively managed with diuretics. | Weak /Low | GRADE standards | Canadian HF (2017) |
Daily weight management | Keep track of the weight of patients who have heart failure and experience fluid retention or congestion that cannot be easily managed with diuretics, or patients who have notable kidney problems. | Weak /Low | GRADE standards | Canadian HF (2017) |
Physical activity/Exercise training | Recommend exercise training or regular PA for HF patients who are capable of participating. Form: NR Duration/Frequency: NR | I/A | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ACC/HFSA HF (2022) |
Physical activity/Exercise training | Recommend exercise for all patients who are capable of participating. Form: NR Duration/Frequency: NR | I/A | ESC Guidelines Classification Scheme | ESC HF (2021) |
Physical activity/Exercise training | Frequently engaging in moderate-intensity continuous exercise can be beneficial for patients diagnosed with stable chronic HF, especially for those with reduced left ventricular ejection fraction (LVEF) Form: Moderate intensity Duration/Frequency: NR | Strong/High | GRADE methodology | Australia HF (2018) |
Physical activity/Exercise training | Regular aerobic exercises for NYHA I – III patients. Form: Walking, treadmill, stationary bicycle as well as swimming Duration/Frequency:30 min/session, 5 days/week | I/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Physical activity/Exercise training | Recommend regular exercise for all HF patients. | Strong/Moderate | GRADE standards | Canadian HF (2017) |
Physical activity/Exercise training | Recommend regular exercise for HF patients to decrease hospital admissions | Strong/Moderate | GRADE standards | Canadian HF (2017) |
Physical activity/Exercise training | Patients with heart failure with reduced ejection fraction (HFrEF) To enhance the quality of life, exercise therapy is utilized to lower the risk of cardiac incidents and increase overall life expectancy. | IIa/B, B/II | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Physical activity/Exercise training | Patients with heart failure with preserved ejection fraction (HFpEF) withlow exercise capacity, utilizing exercise therapy to enhance exercise capacity. | IIa/C, B/IVa | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Physical activity/Exercise training | Patients with heart failure after implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy–defibrillator (CRT-D) implantation, exercise therapy to enhance exercise capacity and quality of life. | IIa/C, B/Iva | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Physical activity/Exercise training | Resistance training can enhance the daily living activities and quality of life for individuals facing advanced deconditioning or reduced physical function. This is achieved by boosting muscle strength and endurance through the training. | IIa/C, B/IVb | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Physical activity/Exercise training | Enhancing overall daily PA is a vital aspect of providing care for patients with stable heart failure. | I/A | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Physical activity/Exercise training | Aerobic exercise training for patients with stable HF, classified as NYHA Class II-III HFrEF Form: treadmill or cycle ergometer or dancing. Duration/Frequency: 20–60 min/time, 3–5 time/week for at least 8–12 weeks Intensity: 50%–90% of peak VO2 or peak work | I/A | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Physical activity/Exercise training | High-intensity interval exercise training in patients with stable HF, classified as NYHA Class II-III HFrE Form: Treadmill or cycle ergometer Duration/Frequency: > 35 min/time, 2–3 times/week for at least 8–12 weeks Intensity: 90%–95% of peak VO2 or peak work, HIIT total exercise doses for each week should be at least 460 kcal, 114 min, or 5.4 MET-hrs | I/A | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Physical activity/Exercise training | Resistance training workouts aimed at targeting the major muscle groups in both the upper and lower body are recommended for individuals with stable HF, classified as NYHA Class II-III HFrE Form: Resistance training Duration/Frequency: the whole duration for at least 8–12 weeks. 3 times/week, 45-60 min/session, 2–3 sets per muscle group Intensity:60%–80% 1RM | I/A | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Physical activity/Exercise training | Combined resistance and aerobic training for patients with stable HF, classified as NYHA Class II-III HFrEF Form: Combined resistance and aerobic training Duration/Frequency: Integrate 20 to 30 min of cardiovascular exercise with an equal duration of strength training, performing 2 to 3 sets for each major muscle group, three times a week, continuously for a minimum of 8 to 12 weeks Intensity: 60%–80% 1RM | II/B | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Physical activity/Exercise training | In outpatient settings, for stable patients with Class II and III HFrEF, whether they have baseline inspiratory muscle weakness or not, inspiratory muscle training can be conducted using threshold devices or similar tools. These devices do not rely on flow-dependent resistance and can be administered both at home and in a clinical setting Form: Inspiratory muscle training Duration/Frequency: Performing exercises for 30 min per day, with an intensity exceeding 30% of your maximal inspiratory pressure (PIMax or MIP), for 5–7 days a week, and continuing this routine for a minimum of 8–12 weeks Intensity: Greater than 30% of PIMax or MIP | I/A | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Physical activity/Exercise training | Outpatients diagnosed with stable HF, classified as Class II and IIIHFrEF, with or without baseline inspiratory muscle weakness, can benefit from a combination of inspiratory muscle training and aerobic exercise training. The program involves the use of a threshold device(or similar) that provides resistance but not dependent on airflow. This training regimen can be administered both at home and in a clinic setting. Form: Simultaneous training of inspiratory muscles and aerobic exercise using a threshold device or similar Duration/Frequency:30 min/day, 5–7 days/week, for at least 8–12 weeks Intensity: > 30% PIMax or MIP | II/B | LOE and GOR utilized by previously published physical therapy CPGs, but reference not given | PT HF (2020) |
Smoking cessation | Smoking cessation | I/C, B/Ivb | COR and LOE similar to those used in ACC/AHA guidelines and the ECS guidelines, and MINDS | JCS /JHFS HF (2017) |
Sleep Disorders | Weight loss is encouraged for OSA patients. | I/C | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Sleep Disorders | CPAP improves daytime sleepiness for obstructive sleep apnea (OSA) patients. | IIa/B | ACC/AHA Clinical Practice Guideline Recommendation Classification System and ESC Guidelines Classification Scheme | Malaysian HF (2019) |
Self-management | Recommend self-management to reduce the risk of hospitalization and mortality associated with HF. | I/A | ESC Guidelines Classification Scheme | ESC HF (2021) |