Utility of Cardiac Rehabilitation Following Surgical Treatment of Infective Endocarditis

Sep 30, 2026

Uploaded by Stanley

Infective endocarditis (IE) is a life-threatening cardiac infection with rising incidence linked to complex sociodemographic changes, including increases in intravenous drug use during opioid epidemics. Cardiac rehabilitation (CR) serves as secondary prevention, and guidelines suggest potential benefit after IE surgery, though prior support remains limited. This narrative review synthesizes available evidence on CR after surgical IE treatment, including data from the CopenHeartIE randomized clinical trial and four case reports.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Keywords

1. Introduction

Rev. Cardiovasc. Med. 2025; 26(12): 45789 [https://doi.org/10.31083/RCM45789](https://doi.org/10.31083/RCM45789) Review Utility of Cardiac Rehabilitation Following Surgical Treatment of Infective Endocarditis Sara M. Telles-Langdon 1, Ali Fatehi Hassanabad 1 , * 1 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB T2N 2T9, Canada *Correspondence: [fatehihassanabad@gmail.com](fatehihassanabad@gmail.com) (Ali Fatehi Hassanabad) Academic Editors: Francesco Giallauria and Bingyang Ji Submitted: 14 August 2025 Revised: 3 November 2025 Accepted: 11 November 2025 Published: 23 December 2025 Abstract Infective endocarditis (IE) is a life-threatening cardiac infection. The incidence of IE is increasing due to complex sociodemographic shifts, including increases in intravenous drug use (IVDU) attributed to opioid epidemics. Cardiac rehabilitation (CR) is a comprehensive form of secondary prevention for heart disease. Current guidelines suggest that CR may be beneficial in the recovery from IE, but supporting evidence is limited. Given the utility of CR in the recovery from other cardiac conditions and the unique characteristics of patients with IE, this narrative review summarizes the existing data on the use of CR following surgical treatment of IE. The existing literature is limited to the CopenHeartIE randomized clinical trial (RCT) and four case reports. Thus, to our knowledge, this represents the first review to focus specifically on CR in the context of IE. The CopenHeartIE RCT found that patients receiving CR showed greater improvements in levels of physical fatigue, general fatigue, maximal power, systolic blood pressure, and some questionnaire scores than the control group. The results of multiple case reports represent unique and extreme cases of IE from which support for the use of CR following IE can be drawn from the relative successes of each patient. Moreover, it is important to consider that the complex social needs of the IE population may require additional psychosocial support, which can be achieved by integrating social workers into the multidisciplinary CR team. While further research is warranted, the existing evidence supports the use of CR as part of the comprehensive recovery from IE. Keywords: infective endocarditis/endocarditis; cardiac rehabilitation; cardiac surgery/thoracic surgery; social determinants of health 1. Introduction Infective endocarditis (IE) is a life-threatening cardiac infection that often requires surgical treatment [1,2] . Despite being relatively rare, IE presents a major public health challenge [1,2] . As the most severe complication of heart valve disease, surgical treatment ofIE is associated with the highest mortality of any valve disease [3] . IE has an increasing annual incidence of up to 12.61 per 100,000 people, and has a ~25% mortality rate, accounting for 77,840 deaths worldwide in 2021 [1,2,4] . Perhaps the most devastating statistic is that the disability adjusted life years (DALYs) attributable to IE were 2,076,413 in 2021, representing an increase globally since 1990 [4] . Therefore, research to optimize recovery and reduce the associated morbidity of IE is of paramount importance. The primary contributing risk factors for IE include rheumatic heart disease (RHD), cardiac implants such as prosthetic valves and indwelling electronic devices, and intravenous drug use (IVDU) [2] . While the incidence of IE is increasing globally, the relative contribution of each category varies between countries with different sociodemographics and healthcare systems [2] . The incidence of RHD-associated IE is decreased in healthcare systems with more robust management of the underlying rheumatic disease [2] . The incidence of cardiac implant-associated IE is increasing, likely due to the increased use of implantable devices worldwide, as advances are made in medical technology and surgic

FAQs

Why is infective endocarditis (IE) considered a major public health challenge?

IE is a life-threatening cardiac infection, and surgical treatment is associated with high mortality among valve diseases. Its annual incidence and burden continue to rise globally.

What does cardiac rehabilitation (CR) aim to do after surgical treatment of IE?

CR is a comprehensive secondary prevention approach intended to support recovery after IE surgery. Current guidelines suggest CR may be beneficial, but evidence has been limited.

What evidence supports the use of CR after IE in the reviewed literature?

The review summarizes results from the CopenHeartIE randomized clinical trial, showing greater improvements in multiple fatigue measures, maximal power, systolic blood pressure, and some questionnaire scores. It also discusses four case reports reflecting extreme and unique IE cases where CR was associated with relative successes.

Sep 30, 2026

Uploaded by Stanley