Exercise-based cardiac rehabilitation for patients with refractory angina: single-center experience

Refractory angina (RA) is a chronic clinical condition characterized by angina pectoris, which occurs as a result of myocardial ischemia, unresponsive to conventional medical treatment (i.e. control of cardiovascular risk factors and other clinical conditions, in addition to antianginal drugs), which is not eligible for coronary interventions. Patients with RA evolve with great functional limitation due to pain and consequent loss of quality of life, and their improvement is the focus of treatment. Exercise-based cardiac rehabilitation (CR) is an adjuvant therapy that effectively promotes secondary prevention in patients with coronary artery disease, but it is rarely prescribed for patients with refractory angina due to concerns about adverse events during exercise, related to triggering ischemia myocardial infarction at low thresholds. In this review, we address the experience obtained with the management of patients with RA in a reference center for the treatment of RA, especially related to exercise-based CR. Some peculiarities in the evaluation and prescription of training in patients with RA and their understanding are important to promote greater safety and efficacy of physical exercise in this population.