Cardiac Rehabilitation: Key Points

Thomas RJ.
Cardiac Rehabilitation — Challenges, Advances, and the Road Ahead. N Engl J Med 2024;390:830-841.

The following are key points to remember from a review article on the benefits of cardiac rehabilitation and current barriers to participation:

  1. Only 25% of people who have had an eligible cardiovascular event participate in cardiac rehabilitation despite its known evidence-based benefits.
  2. Cardiac rehabilitation has many indications including stable angina, stable heart failure with reduced ejection fraction, post–myocardial infarction, post-revascularization by percutaneous coronary intervention or coronary artery bypass grafting, heart transplantation, and peripheral artery disease.
  3. It is essential to enroll patients in cardiac rehab soon after their event. Each day of delay in enrollment decreases participation by 1%.
  4. Cardiac rehab is far more than a supervised exercise program. It includes a thorough initial evaluation followed by a treatment plan that addresses risk factors, exercise habits, psychological health, and quality-of-life goals.
  5. Cardiac rehab is almost always done in a hospital outpatient setting. Home rehab was permitted during the COVID-19 pandemic, but its future is uncertain.
  6. Cardiac rehab is safe, with only one cardiac arrest per 1.3 million patient-hours.
  7. Cardiac rehab may have a small benefit in mortality, but it has a favorable cost-benefit ratio in improving quality-adjusted life-years gained.
  8. Improvement in utilization of cardiac rehab can be achieved with automatic referral systems.
  9. Home-based cardiac rehab may improve care to underserved groups. Results are likely similar.
  10. Some Veterans Administration data show that participation in home-based cardiac rehab decreases mortality by 36% compared to patients who do no cardiac rehab.
  11. There may be a role for expanding cardiac rehab to the period before a planned procedure, in addition to after the procedure.
  12. Much more needs to be done by providers, administrators, professional organizations, and legislators to improve participation in cardiac rehab.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Exercise

Keywords: Cardiac Rehabilitation, Exercise, Patient Care Team

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