A New Era in Cardiac Rehabilitation Delivery: Key Points

Beatty AL, Beckie TM, Dodson J, et al.
A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023;147:254-266.

The following are key points to remember from this review article on delivering cardiac rehabilitation in a new era:

  1. Cardiac rehabilitation programs are proven to reduce rates of hospitalization and mortality and improve quality of life.
  2. Cardiac rehabilitation programs include a structured program of exercise training, risk factor management, and psychosocial counseling and are recommended by the present American College of Cardiology/American Heart Association guidelines.
  3. Despite the benefit of these programs, only 25% of eligible patients enroll, and fewer complete the program.
  4. Disparities in participation based on sex, race, ethnicity, socioeconomic status, and geographic location are striking.
  5. The COVID-19 era caused many programs to go to virtual or remote visits, and this provided an opportunity in many cases to reach and include patients who might have otherwise been unable to participate. The lessons and approaches learned during that period have huge potential for decreasing present-day barriers to access.
  6. Workable models include patients exercising on their own with guidance from staff as well as synchronously with staff input and encouragement.
  7. Studies are underway to construct hybrid models that compare standard with hybrid models for delivery of cardiac rehabilitation.
  8. It is important to recognize that cardiac rehab is more than just the exercise component—and in fact the other components (nutrition, peer support, other counseling) may also be more optimally delivered virtually—which may also affect a patient’s ability to participate without the barrier that travel might pose.
  9. Insurers must embrace innovative models for cardiac rehab, as they did during the 2020 pandemic, if these new virtual and/or hybrid models are to succeed.
  10. Adoption of virtual and hybrid models will necessitate staff training in these new approaches for them to be effective and provide the same outcome benefit of the standard rehabilitation programs. Staff must appreciate how these novel approaches can benefit more patients and break down previously insurmountable barriers to participation.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Cardiac Rehabilitation, Coronary Disease, Counseling, COVID-19, Ethnic Groups, Exercise, Heart Disease Risk Factors, Heart Failure, Myocardial Ischemia, Primary Prevention, Quality of Life, Remote Consultation, Risk Factors, Secondary Prevention, Socioeconomic Factors, Telemedicine, Telerehabilitation

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