ABC | Volume 114, Nº4, April 2020

Short Editorial Ribeiro Balance, quality of life and heart failure Arq Bras Cardiol. 2020; 114(4):708-710 The study of Schmidt et al. 12 shed some light on this issue, as they recruited a sample composed predominantly by women (71%), used the same tools to assess the quality of life and exercise capacity, and concluded that dynamic balance and mobility outperforms exercise capacity in capturing HFpEF patients’ quality of life. Collectively, these findings reinforce the importance of carrying out studies in women with HFpEF to identify determinants of their quality of life. The high mortality, morbidity, cardiovascular and heart failure readmission rates, and health care use and costs associated with the increase in heart failure prevalence clearly signal the need to improve treatment strategies. The study of Schmidt et al .12 certainly leaves the reader with the feeling that there is an important aspect of HFpEF care that could be missing in old age patients. As an independent predictor of quality of life, should all old age patients be tested for dynamic balance and mobility? Balance deficits are potentially treatable, and identifying and treating such deficits may improve patients’ quality of life. Further investigation with larger sample size is needed to strengthen or refute Schmidt et al. 12 conclusions and help clinicians decide whether to test or not balance daily. The study of Schmidt et al. 12 by suggesting dynamic balance and mobility as the most important determinant of quality of life (both physical and emotional dimensions), raises also another pertinent question: is it time to include balance training in the cardiac rehabilitation programs of patients with HFpEF? Exercise-based cardiac rehabilitation is a class 1A recommendation for heart failure patients; 2 in patients with HFpEF the benefits are multi-dimensional, for instance, an exercise-based cardiac rehabilitation program improves exercise capacity, diastolic function, and quality of life. 14-16 Nonetheless, traditional cardiac rehabilitation programs do not fully address the multi-domain functional impairments common in older patients with HFpEF, particularly balance and functional mobility impairments. The response to the above-mentioned question could be given in studies assessing the impact of multi-domain cardiac rehabilitation programs designed to also improve balance and functional mobility (in addition to other goals such as improve exercise capacity) administered by a multi-disciplinary team; and, assessing whether a program encompassing specific balance and functional mobility exercises in addition to aerobic and resistance exercise is more effective to improve balance and quality of life, decrease the risk and rate of fall, and to reduce cardiovascular and non-cardiovascular hospitalizations. In summary, the current contribution by Schmidt et al. 12 in this issue of ABC raises awareness and provides evidence to advocate assessing dynamic balance and mobility in old age patients with HFpEF. However, before this is implemented in clinical routine, their findings need to be strengthened in future studies. 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