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However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and\u00a0\u2013\u00a0with less certainty\u00a0\u2013\u00a0testosterone in highly selected patients. Erythropoiesis\u2010stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co\u2010morbidities such as sleep\u2010disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin\u2010converting enzyme inhibitors, angiotensin receptor blockers, beta\u2010blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril\/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril\/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state\u2010of\u2010the\u2010art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co\u2010morbidities may be important for these patient\u2010related outcomes. Additional studies on functional capacity and quality of life in heart failure are required.<\/jats:p>","DOI":"10.1002\/ejhf.1838","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T14:56:22Z","timestamp":1589208982000},"page":"92-113","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":103,"title":["Improving exercise capacity and quality of life using non\u2010invasive heart failure treatments: evidence from clinical trials"],"prefix":"10.1093","volume":"23","author":[{"given":"Stephan","family":"von Haehling","sequence":"first","affiliation":[{"name":"Department of Cardiology and Pneumology University of G\u00f6ttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Arzt","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II University Hospital Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Doehner","sequence":"additional","affiliation":[{"name":"BCRT \u2010 Berlin Institute of\u2009Health\u2009Center for Regenerative Therapies Charit\u00e9 \u2010 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Department of Internal Medicine and Cardiology Charit\u00e9\u00a0\u2013\u00a0Universit\u00e4tsmedizin Berlin, Campus Virchow\u2010Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Edelmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology Charit\u00e9\u00a0\u2013\u00a0Universit\u00e4tsmedizin Berlin, Campus Virchow\u2010Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Evertz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University of G\u00f6ttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Ebner","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University of G\u00f6ttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Herrmann\u2010Lingen","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy University of G\u00f6ttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Garfias Macedo","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University of G\u00f6ttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Koziolek","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Rheumatology University of G\u00f6ttingen Medical Center  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Noutsias","sequence":"additional","affiliation":[{"name":"Mid\u2010German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III University Hospital Halle, Martin\u2010Luther\u2010University Halle  Halle (Saale) Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. 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