Regenerative Principles Enrich Cardiac Rehabilitation Practice

Abstract

Cardiovascular morbidity imposes a high degree of disability and mortality, with limited therapeutic options available in end-stage disease. Integral to standard-of-care, cardiac rehabilitation aims on improving quality of life and prolonging survival. The recent advent of regenerative technologies paves the way for a transformative era in rehabilitation medicine whereby, beyond controlling risk factors and disease progression, the prospect of curative solutions is increasingly tangible. To date, the spectrum of clinical experience in cardiac regenerative medicine relies on stem cell-based therapies delivered to the diseased myocardium either acutely/subacutely, following a coronary event, or in the setting of chronic heart failure. Application of autologous/allogeneic stem cell platforms has established safety and feasibility, with encouraging signals of efficacy. Newer protocols aim to purify cell populations in an attempt to eliminate non-regenerative and enrich for regenerative cell types prior to use. Most advanced technologies have been developed to isolate resident cell populations directly from the heart, or alternatively condition cells from non-cardiac sources to attain a disease targeted lineage-specified phenotype for optimized outcome. As a multiplicity of cell-based technologies has undergone Phase I/II evaluation, pivotal trials are currently underway in larger patient populations. Translation of regenerative principles into clinical practice will increasingly involve rehabilitation providers across the continuum of patient care. Regenerative rehabilitation is thus an emerging multidisciplinary field, full of opportunities and ready to be explored.

Regional Variability in the Access to Cardiac Rehabilitation in Poland

“…Moreover, equal access to health services is one of the priorities of Polish health policy [ 47 ] and an important value of the healthcare system, as in the case of many healthcare systems over the world [ 48 ]. In addition, the establishment and development of CR services is essential for the most effective management of heart conditions [ 11 , 49 ]. Therefore, it is of high priority to verify the equity in the geographical access to CR in Poland.…”

Mechanisms and Therapeutic Targets of Cardiac Regeneration: Closing the Age Gap

“…The World Health Organization and the European Cardiovascular Disease Statistics indicate that cardiovascular disease causes over 4 million deaths in Europe each year, and more than 40% of these deaths are attributable to MI. Due to the considerable improvement in reperfusion techniques the survival rate of patients following MI has been dramatically improved ( 5 , 6 ). However, HF is a frequent complication of MI and remains a major cause of morbidity and mortality worldwide ( 7 ).…”