The role of cardiac rehabilitation in improving cardiovascular outcomes

Abstract

Cardiac rehabilitation is a complex intervention that includes exercise training, physical activity promotion, health education, cardiovascular risk management and psychological support, personalized to the individual needs of patients with diagnosed heart disease 1 (Fig. 1). In addition to secondary prevention and improvement in cardiovascular prognosis, a focus of modern cardiac rehabilitation has been the drive to improve patient wellbeing and health-related quality of life [2][3][4] .Introduced in the late 1960s, the recommendation for the provision of cardiac rehabilitation was, at that time, confined to low-risk patients who had survived an acute myocardial infarction (MI). With the development of an evidence base over the past two decades supporting the benefits of cardiac rehabilitation, contemporary clinical guidelines now routinely recommend the referral to comprehensive cardiac rehabilitation across a wider range of cardiac diagnoses, including acute coronary syndrome, heart failure with reduced ejection fraction (HFrEF) and coronary revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery).An important emphasis of contemporary guidelines, including the 2020 position statement from the European Association of Preventive Cardiology (EAPC) 5 , the 2017 guidance from the British Association for Cardiovascular Prevention and Rehabilitation 6 and the 2020 position statement from the Secondary Prevention and Rehabilitation Section of EAPC, is the importance of quality assurance in cardiac rehabilitation delivery 7 (Box 1). Key quality assurance elements include the involvement of a multidisciplinary team (including cardiologists, general practitioners and physicians with special interest, nurse specialists, physiotherapists, dietitians and psychologists) trained in the core competencies and effective delivery of the various core elements of a comprehensive cardiac rehabilitation programme (that is, exercise training and promotion, risk factor and self-management education, and psychological support) 1,6 , following a detailed initial assessment of the patient. Initially, cardiac rehabilitation was primarily practised as an exercise training intervention alone 8 . Although exercise training remains a central component of cardiac rehabilitation, the comprehensive model

Prevalence of US Adults With Cardiovascular Disease Reporting Barriers to Clinician Office Visits

“…It remains unknown whether all centers will have the financial resources to reopen. Some programs began to instead offer home-based or hybrid CR 18,52–55. Home-based models may reduce overall costs associated with CR as was found in the FIT@Home study 56.…”

“…Home-based models may reduce overall costs associated with CR as was found in the FIT@Home study 56. Although home-based telerehabilitation mitigates risk of COVID-19 contagion and inherently reduces many barriers to center-based CR attendance, unless it is reimbursable at the same rate as center-based CR and preserves the core-components of center-based CR, widespread adoption by CR clinicians is unlikely 18,19,52…”

Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe

“…Inpatients and outpatients who had not been referred to CR were approached. Eligible patients had to meet the following criteria: ≥18 years and diagnosis of coronary heart disease, specifically coronary artery disease (CAD), acute coronary syndrome, heart failure, arrhythmias, or valve defects, and/or having undergone percutaneous coronary intervention or coronary artery bypass graft surgery, as per CR indications in clinical practice guidelines [ 22 ]. Exclusion criteria included significant acute cardiovascular risk, implanted cardioverter-defibrillator/pacemaker, orthopedic/neurological disorders severely limiting movement training, and participation-excluding mental disorders (e.g., schizophrenia, advanced dementia).…”

Effects of Cardiac Telerehabilitation During COVID-19 on Cardiorespiratory Capacities in Patients With Coronary Artery Disease

“…This virus spread very rapidly throughout the world and caused many economic, social, and health consequences ( Pericàs et al, 2020 ). The latest repercussion led to the saturation of hospital services which were forced to close rehabilitation centers ( Taylor et al, 2021 ). Therefore, in many institutes or specialized CR clinics, the programs were partially interrupted or suspended according recommendations of scientific and public health authorities ( Haute Autorité de Santé, 2020 ; Ministère des Solidarités et de la Santé, 2020 ).…”

“…This therapy includes remotely supervised exercise training and collective or individual cardiac prevention and management heart disease meetings by videoconference ( Scherrenberg et al, 2021 ). To demonstrate the effectiveness of cardiac telerehabilitation, some studies have focused on quality of life, mainly assessed by questionnaires ( Gooley et al, 2021 ; Taylor et al, 2021 ). Patients also suffer from physical limitations such as shortness of breath, lack of fitness, and fatigue during exercise.…”