{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:11:15Z","timestamp":1793311875058,"version":"4.5.0"},"reference-count":82,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T00:00:00Z","timestamp":1733443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Heart failure with reduced ejection fraction (HFrEF) is a condition marked by diminished cardiac output and impaired oxygen delivery to tissues. Exercise, once avoided in HFrEF patients due to safety concerns, is now recognized as an important therapeutic intervention. Structured exercise improves various physiological, biochemical, and analytical parameters, including cardiac output, endothelial function, skeletal muscle performance, and autonomic regulation. Biochemically, exercise induces favorable changes in inflammatory markers, lipid profiles, glucose metabolism, and renal function. This paper reviews these changes, highlighting how exercise can be safely incorporated into HFrEF management. Further research is needed to tailor exercise interventions for individual patients to optimize outcomes.<\/jats:p>","DOI":"10.3390\/medicina60122017","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T06:16:14Z","timestamp":1733724974000},"page":"2017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of Exercise on Physiological, Biochemical, and Analytical Parameters in Patients with Heart Failure with Reduced Ejection Fraction"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5547-4025","authenticated-orcid":false,"given":"Francisco","family":"Epelde","sequence":"first","affiliation":[{"name":"Medicine Department, Parc Taul\u00ed Hospital Universitari, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed I3PT, 08208 Sabadell, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,6]]},"reference":[{"key":"ref_1","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1161\/CIRCULATIONAHA.122.057444","article-title":"Management of Atrial Fibrillation Across the Spectrum of Heart Failure With Preserved and Reduced Ejection Fraction","volume":"146","author":"Reddy","year":"2022","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1016\/S0140-6736(05)66621-4","article-title":"Heart failure","volume":"365","author":"McMurray","year":"2005","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"ITC177","DOI":"10.7326\/AITC202312190","article-title":"Management of Heart Failure in Hospitalized Patients","volume":"176","author":"Kittleson","year":"2023","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2023.04.019","article-title":"Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure","volume":"82","author":"Mentz","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1038\/s41569-021-00605-5","article-title":"Heart failure with mid-range or mildly reduced ejection fraction","volume":"19","author":"Savarese","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1177\/1742395320920700","article-title":"A randomized controlled trial of high-intensity interval training and inspiratory muscle training for chronic heart failure patients with inspiratory muscle weakness","volume":"18","author":"Sadek","year":"2022","journal-title":"Chronic Illn."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1080\/17476348.2023.2293226","article-title":"Effects of cardiorespiratory rehabilitation program on submaximal exercise in patients with long-COVID-19 conditions: A systematic review of randomized controlled trials and recommendations for future studies","volume":"17","author":"Ghram","year":"2023","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1136\/heartjnl-2020-318553","article-title":"Biomarkers in heart failure: A focus on natriuretic peptides","volume":"110","author":"Eltayeb","year":"2024","journal-title":"Heart"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1161\/CIRCRESAHA.121.318186","article-title":"Pathophysiology and Therapeutic Approaches to Acute Decompensated Heart Failure","volume":"128","author":"Njoroge","year":"2021","journal-title":"Circ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1183\/16000617.0048-2016","article-title":"Exertional dyspnoea in chronic heart failure: The role of the lung and respiratory mechanical factors","volume":"25","author":"Agostoni","year":"2016","journal-title":"Eur. Respir. Rev."},{"key":"ref_12","first-page":"911","article-title":"Activit\u00e9 r\u00e9nine et aldost\u00e9rone plasmatiques au cours d\u2019un exercice submaximal. Effets de l\u2019entra\u00eenement [Plasma renin activity (PRA) and aldosterone (PA) during submaximal exercise. Effect of training (author\u2019s transl)]","volume":"77","author":"Gharib","year":"1981","journal-title":"J. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1139\/apnm-2019-0130","article-title":"\u03b2-Adrenoreceptors do not oppose sympathetic vasoconstriction in resting and contracting skeletal muscle of male rats","volume":"44","author":"Cooper","year":"2019","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"121511","DOI":"10.1016\/j.lfs.2023.121511","article-title":"Effects of different exercise modalities on inhibiting left ventricular pathological remodeling in patients with heart failure with reduced ejection fraction: A systematic review and network meta-analysis","volume":"319","author":"Wang","year":"2023","journal-title":"Life Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1139\/cjpp-2022-0154","article-title":"Future scope and challenges for congestive heart failure: Moving toward development of pharmacotherapy","volume":"100","author":"Dhalla","year":"2022","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Szlagor, M., Dybiec, J., M\u0142ynarska, E., Rysz, J., and Franczyk, B. (2023). Chronic Kidney Disease as a Comorbidity in Heart Failure. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24032988"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/1071-9164(95)90001-2","article-title":"Skeletal muscle fiber composition and capillarization in patients with chronic heart failure: Relation to exercise capacity and central hemodynamics","volume":"1","author":"Schaufelberger","year":"1995","journal-title":"J. Card. Fail."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Saw, E.L., Werner, L.D., Zamani, P., Chirinos, J.A., Valero-Mu\u00f1oz, M., and Sam, F. (2022). Skeletal muscle phenotypic switching in heart failure with preserved ejection fraction. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1016452"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kourek, C., Briasoulis, A., Zouganeli, V., Karatzanos, E., Nanas, S., and Dimopoulos, S. (2022). Exercise Training Effects on Circulating Endothelial and Progenitor Cells in Heart Failure. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9070222"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.resp.2016.04.007","article-title":"Determination of normal values for an isocapnic hyperpnea endurance test in healthy individuals","volume":"230","author":"Vincent","year":"2016","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.resp.2016.09.010","article-title":"Exercice-induced bronchoconstriction among athletes: Assessment of bronchial provocation tests","volume":"235","author":"Vakali","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1536\/ihj.23-326","article-title":"Electromyogram Power Spectrum and Cardiac Function Changes After Combined Aerobic Interval Training and Inspiratory Muscle Training in Chronic Heart Failure Patients","volume":"65","author":"Sadek","year":"2024","journal-title":"Int. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s10741-023-10310-9","article-title":"Practical guidelines for exercise prescription in patients with chronic heart failure","volume":"28","author":"Taylor","year":"2023","journal-title":"Heart Fail. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.18087\/cardio.2023.8.n1682","article-title":"Right ventricular and right atrial free wall deformation predicitive value in transformation of preclinical diastolic disfunction to heart failure with preserved ejection fraction","volume":"63","author":"Tunyan","year":"2023","journal-title":"Kardiologiia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1139\/apnm-2016-0393","article-title":"Linking skeletal muscle blood flow and metabolism to the limits of human performance","volume":"42","author":"Boushel","year":"2017","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1139\/apnm-2015-0637","article-title":"Short-term exercise training improves flow-mediated dilation and circulating angiogenic cell number in older sedentary adults","volume":"41","author":"Corrigan","year":"2016","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1042\/CS20231197","article-title":"Skeletal muscle dysfunction with advancing age","volume":"138","author":"Pabla","year":"2024","journal-title":"Clin. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"106038","DOI":"10.1016\/j.phrs.2021.106038","article-title":"Mitochondrial dysfunction and mitochondrial therapies in heart failure","volume":"175","author":"Wu","year":"2022","journal-title":"Pharmacol. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Drera, A., Rodella, L., Brangi, E., Riccardi, M., and Vizzardi, E. (2024). Endothelial Dysfunction in Heart Failure: What Is Its Role?. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092534"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Tsigkou, V., Oikonomou, E., Anastasiou, A., Lampsas, S., Zakynthinos, G.E., Kalogeras, K., Katsioupa, M., Kapsali, M., Kourampi, I., and Pesiridis, T. (2023). Molecular Mechanisms and Therapeutic Implications of Endothelial Dysfunction in Patients with Heart Failure. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054321"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1002\/ehf2.13255","article-title":"Sarcopenia in heart failure: A systematic review and meta-analysis","volume":"8","author":"Zhang","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lena, A., Anker, M.S., and Springer, J. (2020). Muscle Wasting and Sarcopenia in Heart Failure\u2014The Current State of Science. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21186549"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.pcad.2024.01.002","article-title":"Role of exercise therapy and cardiac rehabilitation in heart failure","volume":"82","author":"Patel","year":"2024","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.jacc.2022.07.004","article-title":"Exercise for Primary and Secondary Prevention of Cardiovascular Disease: JACC Focus Seminar 1\/4","volume":"80","author":"Tucker","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Costache, A.D., Ma\u0219taleru, A., Leon, M.M., Roca, M., Gavril, R.S., Cos\u0103u, D.E., Rotundu, A., Amagdalinei, A.I., Mitu, O., and Costache Enache, I.I. (2024). High-Intensity Interval Training vs. Medium-Intensity Continuous Training in Cardiac Rehabilitation Programs: A Narrative Review. Medicina, 60.","DOI":"10.3390\/medicina60111875"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1139\/apnm-2020-0900","article-title":"Effects of dynamic and isometric resistance training protocols on metabolic profile in hemodialysis patients: A randomized controlled trial","volume":"46","author":"Rosa","year":"2021","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s10554-019-01738-y","article-title":"Stroke volume and cardiac output measurement in cardiac patients during a rehabilitation program: Comparison between tonometry, impedancemetry and echocardiography","volume":"36","author":"Mourot","year":"2020","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1046\/j.1365-2281.2001.00328.x","article-title":"Chronotropic incompetence response to exercise in congestive heart failure, relationship with the cardiac autonomic status","volume":"21","author":"Roche","year":"2001","journal-title":"Clin. Physiol."},{"key":"ref_39","first-page":"323","article-title":"Adaptation du coeur normal et du coeur isch\u00e9mique \u00e0 l\u2019exercice musculaire [Adaptation of the normal and ischemic heart to muscular exertion]","volume":"35","author":"Denolin","year":"1986","journal-title":"Ann. Cardiol. Angeiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.echo.2014.07.007","article-title":"Endurance training minimizes age-related changes of left ventricular twist-untwist mechanics","volume":"27","author":"Maufrais","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mollace, R., Scarano, F., Bava, I., Carresi, C., Maiuolo, J., Tavernese, A., Gliozzi, M., Musolino, V., Muscoli, S., and Palma, E. (2023). Modulation of the nitric oxide\/cGMP pathway in cardiac contraction and relaxation: Potential role in heart failure treatment. Pharmacol. Res., 196.","DOI":"10.1016\/j.phrs.2023.106931"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"McCarty, M.F. (2021). Nutraceutical, Dietary, and Lifestyle Options for Prevention and Treatment of Ventricular Hypertrophy and Heart Failure. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22073321"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11897-022-00584-9","article-title":"C-Reactive Protein, Interleukin-6, Trimethylamine-N-Oxide, Syndecan-1, Nitric Oxide, and Tumor Necrosis Factor Receptor-1 in Heart Failure with Preserved Versus Reduced Ejection Fraction: A Meta-Analysis","volume":"20","author":"Gui","year":"2023","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1023\/A:1020758300499","article-title":"Nitric oxide, cell death, and heart failure","volume":"7","author":"Oyama","year":"2002","journal-title":"Heart Fail. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1139\/apnm-2019-0602","article-title":"Aerobic exercise training-induced irisin secretion is associated with the reduction of arterial stiffness via nitric oxide production in adults with obesity","volume":"45","author":"Inoue","year":"2020","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1002\/ejhf.1320","article-title":"Treating oxidative stress in heart failure: Past, present and future","volume":"21","author":"Voors","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.stem.2022.03.003","article-title":"Uncompensated mitochondrial oxidative stress underlies heart failure in an iPSC-derived model of congenital heart disease","volume":"29","author":"Xu","year":"2022","journal-title":"Cell Stem Cell"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.hfc.2018.12.006","article-title":"Ventricular Stiffness and Ventricular-Arterial Coupling in Heart Failure: What Is It, How to Assess, and Why?","volume":"15","author":"Shim","year":"2019","journal-title":"Heart Fail Clin."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/HJH.0000000000002619","article-title":"Exercise training reduces arterial stiffness in adults with hypertension: A systematic review and meta-analysis","volume":"39","author":"Lopes","year":"2021","journal-title":"J. Hypertens."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Park, W., Jung, W.S., Hong, K., Kim, Y.Y., Kim, S.W., and Park, H.Y. (2020). Effects of Moderate Combined Resistance- and Aerobic-Exercise for 12 Weeks on Body Composition, Cardiometabolic Risk Factors, Blood Pressure, Arterial Stiffness, and Physical Functions, among Obese Older Men: A Pilot Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17197233"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3703","DOI":"10.1113\/JP274172","article-title":"Exercise training reverses age-induced diastolic dysfunction and restores coronary microvascular function","volume":"595","author":"Hotta","year":"2017","journal-title":"J. Physiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1249\/MSS.0000000000001854","article-title":"Aerobic Exercise Improves Microvascular Function in Older Adults","volume":"51","author":"Hurley","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Scarf\u00f2, G., Daniele, S., Chelucci, E., Rizza, A., Fusi, J., Freggia, G., Costa, B., Taliani, S., Artini, P., and Martini, C. (2023). Regular exercise delays microvascular endothelial dysfunction by regulating antioxidant capacity and cellular metabolism. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-44928-4"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Working Group on Cardiac Rehabilitation & Exercice Physiology and Working Group on Heart Failure of the European Society of Cardiology (2001). Recommendations for exercise training in chronic heart failure patients. Eur. Heart J., 22, 125\u2013135.","DOI":"10.1053\/euhj.2000.2440"},{"key":"ref_55","first-page":"845225","article-title":"High-Intensity Interval Training Programs Versus Moderate-Intensity Continuous Training for Individuals With Heart Failure: A Systematic Review and Meta-analysis","volume":"9","author":"Chen","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1093\/europace\/eum066","article-title":"Physiological approach to monitor patients in congestive heart failure: Application of a new implantable device-based system to monitor daily life activity and ventilation","volume":"9","author":"Page","year":"2007","journal-title":"Europace"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Epelde, F. (2024). Current Status, Challenges, and Future Directions in Cardiac Rehabilitation. Medicina, 60.","DOI":"10.3390\/medicina60030388"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1161\/CIRCRESAHA.119.312321","article-title":"Obesity, Hypertension, and Cardiac Dysfunction: Novel Roles of Immunometabolism in Macrophage Activation and Inflammation","volume":"126","author":"Mouton","year":"2020","journal-title":"Circ. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1038\/s41569-023-00964-1","article-title":"Immune and inflammatory mechanisms in hypertension","volume":"21","author":"Guzik","year":"2024","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.ijcard.2017.05.048","article-title":"Influence of renal dysfunction phenotype on mortality in decompensated heart failure with preserved and mid-range ejection fraction","volume":"243","author":"Casado","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1007\/s40520-019-01363-8","article-title":"Differential characteristics of acute heart failure in very elderly patients: The prospective RICA study","volume":"32","author":"Franco","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s11886-021-01588-y","article-title":"Improving Quality of Life in Heart Failure","volume":"23","author":"Freedland","year":"2021","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1161\/CIRCULATIONAHA.120.050850","article-title":"Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries","volume":"143","author":"Johansson","year":"2021","journal-title":"Circulation"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s11739-020-02326-y","article-title":"Residual congestion and long-term prognosis in acutely decompensated heart failure patients","volume":"15","author":"Ceriani","year":"2020","journal-title":"Intern. Emerg. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ijcard.2020.09.072","article-title":"Long-term Follow-Up of Patients with Heart Failure and Reduced Ejection Fraction Receiving Autonomic Regulation Therapy in the ANTHEM-HF Pilot Study","volume":"323","author":"Sharma","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"131161","DOI":"10.1016\/j.ijcard.2023.131161","article-title":"Association of pre-hospital precipitating factors with short- and long-term outcomes of acute heart failure patients: A report from the WET-HF2 registry","volume":"389","author":"Ichihara","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e225982","DOI":"10.1001\/jamanetworkopen.2022.5982","article-title":"Effectiveness and Cost-effectiveness of an Empowerment-Based Self-care Education Program on Health Outcomes Among Patients with Heart Failure: A Randomized Clinical Trial","volume":"5","author":"Yu","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Driscoll, A., Gao, L., and Watts, J.J. (2022). Clinical effectiveness and cost-effectiveness of ambulatory heart failure nurse-led services: An integrated review. BMC Cardiovasc. Disord., 22.","DOI":"10.1186\/s12872-022-02509-9"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.amjcard.2017.06.071","article-title":"Cost-Effectiveness of Multidisciplinary Management Program and Exercise Training Program in Heart Failure","volume":"120","author":"Dang","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.carpath.2011.11.007","article-title":"The pathophysiology of heart failure","volume":"21","author":"Kemp","year":"2012","journal-title":"Cardiovasc. Pathol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Sakaguchi, A., Nishiyama, C., and Kimura, W. (2020). Cardiac regeneration as an environmental adaptation. Biochim. Biophys. Acta Mol. Cell Res., 1867.","DOI":"10.1016\/j.bbamcr.2019.118623"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1097\/HCO.0000000000000276","article-title":"Epigenetic regulation in heart failure","volume":"31","author":"Kim","year":"2016","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00392-011-0341-0","article-title":"Biomarkers: Optimizing treatment guidance in heart failure","volume":"100","author":"Voors","year":"2011","journal-title":"Clin. Res. Cardiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s40265-023-01887-4","article-title":"Guideline-Directed Medical Therapy for the Treatment of Heart Failure with Reduced Ejection Fraction","volume":"83","author":"Patel","year":"2023","journal-title":"Drugs"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1093\/ckj\/sfad031","article-title":"Kidney function changes in acute heart failure: A practical approach to interpretation and management","volume":"16","author":"Kenneally","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s10741-023-10346-x","article-title":"Assessment and management of heart failure in patients with chronic kidney disease","volume":"29","author":"Guaricci","year":"2024","journal-title":"Heart Fail. Rev."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s10741-021-10105-w","article-title":"Biomarkers for the diagnosis and management of heart failure","volume":"27","author":"Castiglione","year":"2022","journal-title":"Heart Fail. Rev."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.tcm.2022.11.001","article-title":"Precision medicine: Hype or hope?","volume":"34","author":"Pelter","year":"2024","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_80","first-page":"147","article-title":"Artificial Intelligence in Heart Failure and Acute Kidney Injury: Emerging Concepts and Controversial Dimensions","volume":"14","author":"Cheungpasitporn","year":"2024","journal-title":"Cardiorenal Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/ejhf.3024","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"26","author":"McDonagh","year":"2024","journal-title":"Eur. J. Heart Fail."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Epelde, F. (2024). Optimizing Cardiac Rehabilitation in Heart Failure: Comprehensive Insights, Barriers, and Future Strategies. Medicina, 60.","DOI":"10.3390\/medicina60101583"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/12\/2017\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:49:09Z","timestamp":1760114949000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/12\/2017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,6]]},"references-count":82,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["medicina60122017"],"URL":"https:\/\/doi.org\/10.3390\/medicina60122017","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,6]]}}}