This post was authored by Richard A. Josephson, MS, MD, FACC, member of the ACC Prevention of Cardiovascular Disease Section Leadership Council, and Derin Tugal, MD, a fellow in training at Case Medical Center, University Hospitals of Cleveland and a member of the ACC Prevention of Cardiovascular Disease Section.

Cardiac rehabilitation (rehab) offers patients with coronary artery disease (CAD), recent revascularizations or cardiac surgery, or heart failure, a comprehensive individualized program of supervised exercise, health education, advice on lifestyle behavior modification, physical activity and psychological stress management. There is growing appreciation of the benefit of exercise-based cardiac rehab on reduced cardiovascular mortality, morbidity, unplanned hospitalizations, exercise capacity, health-related quality of life and psychological well-being.

The Journal of the American College of Cardiology recently published a Cochrane systematic review and meta-analysis of exercise-based cardiac rehab for patients with coronary heart disease, which demonstrated the benefit of this therapy in this patient population and supported the class I ACC/American Heart Association (AHA) recommendation that cardiac rehab be an integral part of patient care.

Interestingly, the study found that while exercise-based cardiac rehab showed a reduction in cardiovascular mortality (number needed to treat of 37) there was no benefit observed with respect to recurrent myocardial infarction, revascularization and all-cause mortality. The authors attributed the absence of all-cause mortality risk reduction, as contrasted with older studies, to optimization of medical therapy over time. Indeed, a trend was observed over the nearly 20-year study period during which there was a linear reduction in the all-cause mortality effect of cardiac rehab.

Despite numerous publications and international guidelines in support of cardiac rehab for patients after acute coronary syndrome, coronary revascularization, cardiac surgery, and heart failure, implementation of cardiac rehab remains suboptimal. Participation rates of less than 50 percent frustrate our potential to optimally treat our patients. The ACC is focused on provider and patient education and has created resources to enhance net participation.

The College’s patient-centered online resource, CardioSmart.org, has a cardiac rehab “hub,” with a concise yet comprehensive review of the indications for cardiac rehab, benefits of patient participation with the potential for physical as well as emotional health improvement. The hub also provides information regarding diet and lifestyle modification, exercise, cardiac testing, and phases of cardiac rehab that facilitates the transition from inpatient to outpatient supervised and ultimately unsupervised cardiac rehab. Importantly, the benefit of continued program participation without exercise for patients with high-risk cardiovascular features, such as unstable angina or decompensated heart failure, is addressed. In addition to encouraging a close relationship with a team of health care providers, CardioSmart provides contact and website information for ancillary community and national resources, including the AHA, HeartHub and the National Heart, Lung, and Blood Institute.

As a community, we are responsible for encouraging the participation of our patients in a net cost-effective exercise-based cardiac rehab program. Primed with our knowledge of and growing resources for cardiac rehab, our patients deserve the opportunity to benefit from the multifaceted program.

National Cardiac Rehabilitation Week is Feb. 14 – 20. Encourage patient to learn more about cardiac rehab at CardioSmart.org/CardiacRehab and share ACC’s CardioSmart Cardiac Rehab infographic.

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