Comprehensive Cardiac Rehabilitation in Heart Failure: A Narrative Review of Phenotype-Specific Modalities, Risk Stratification, and Clinical Outcomes

Background/Objectives: Cardiac rehabilitation addresses exercise intolerance and impaired quality of life in heart failure. This review examines clinical assessment, exercise prescription, multidisciplinary care, and rehabilitation delivery across populations described using historical HFrEF, HFmrEF, and HFpEF. Methods: This narrative review discusses randomized trials, observational studies, systematic reviews, professional guidelines, and position statements. Functional and patient-reported outcomes are considered separately from hospitalization and mortality, with attention to population differences and limitations of extrapolation. Results: Exercise intolerance reflects varying contributions from central haemodynamic limitations, peripheral abnormalities, and comorbidities. CPET can support functional assessment and individualized exercise prescription. Aerobic and resistance training improve selected functional outcomes, while complementary interventions should address individual clinical needs. Evidence supports improvements in health-related quality of life and reductions in all-cause hospital admissions, whereas mortality effects remain uncertain. Direct evidence is uneven across historical LVEF categories and advanced HF populations. Conclusions: Rehabilitation should be individualized according to stability, functional capacity, comorbidities, and patient preferences. Historical categories are retained to preserve the population definitions of the underlying studies despite the revised 2026 ESC classification. Home-based and hybrid programmes provide additional delivery options, while omics-guided approaches require further validation.