Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO₂) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET’s effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes.

Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF), including angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor-neprilysin inhibitors (ARNI), beta blockers (BB), mineralocorticoid receptor antagonists (MRA) and sodium/glucose co-transporter 2 (SGLT2) inhibitors, which all improve survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation and exercise training can play an important role in both HFrEF and HFpEF. Cardiac rehabilitation significantly improves functional capacity, exercise duration and quality of life. Exercise training has shown beneficial effects on peak oxygen consumption (pVO2) and 6-minute walk test distance in HFrEF and HFpEF patients as well as a reduction in hospitalisation and mortality rates. ET also has been shown to have beneficial effects on depression and anxiety levels. High intensity training and moderate continuous training have both shown benefit, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme but prescription rates remain low worldwide. Further research is required to establish the most efficacious exercise prescriptions in patients with HFrEF and HFpEF, but personalised exercise regimens should be considered as part of HF management.

Background: Appendicectomy remains the gold standard treatment for acute appendicitis. While there is continued debate as to the clinical benefit of conservative treatment in acute appendicitis, the cost-effectiveness of each treatment is a critical consideration. The aim of this study is to evaluate the current health economic evidence for surgery versus conservative management in acute appendicitis. Methods: A systematic literature search of 3 online databases for evidence pertaining to the economics of appendectomy compared with conservative management was performed according to PRISMA standards. The study protocol was prospectively registered with PROSPERO (study ID: CRD42023412691). Results: A total of 1219 patients were included (639 operative treatment vs. 580 conservative management). A total of 5 studies were included. Surgery was significantly more expensive when compared with conservative treatment (16.5% to 83.0%) percentage cost difference. The average length of hospitalisation was similar between the groups. The majority of studies reported a 12-month follow-up. The CHEERS assessment revealed a considerable risk of bias. Conclusion: Conservative management of appendicitis is the more economically effective treatment of the 2 modalities. This is an important consideration for resource-limited health care systems. However, further research with standardized methodologies and longer-term follow-up is warranted to fully assess the economic implications and clinical effectiveness of both treatment approaches. Key statement: Analysis indicates conservative management as the economically preferable option for acute appendicitis over surgery. This finding underscores its potential significance for resource-constrained health care systems. However, standardized studies with extended follow-up in different global health care settings are required to evaluate the economic and clinical merits of both treatment strategies.