Abstract
Purpose of review
To provide updated information on the science and practice of cardiac rehabilitation (CR).
Recent findings
Evidence continues to mount that supports the many benefits of CR as well as the important gap in delivering CR to all eligible patients. Recent studies have identified center-based and home-based strategies to improve the reach and impact of CR.
Summary
Cardiac rehabilitation is a systematic, evidence-based approach to deliver effective secondary CVD preventive therapies to individuals with cardiovascular conditions. Because of a number of benefits that have been associated with CR, clinical practice guidelines strongly endorse CR services for eligible patients. Research supports CR as a high value service, with evidence of favorable clinical outcomes and costs. Unfortunately, a significant gap exists in CR participation due to a number of patient-, provider-, and system-level barriers. Solutions to most of these barriers have been identified and involve systematic approaches to CR delivery. The future is bright for CR as new strategies, new policies, and new methods of delivery continue to develop to help provide CR services to all eligible patients.
Similar content being viewed by others
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hellerstein HK, Ford AB. Rehabilitation of the cardiac patient. J Am Med Assoc. 1957;164(3):225–31.
Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007;115(20):2675–82.
Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med. 2014;127(6):538–46.
Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12.
Heran BS, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;7:CD001800.
Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. 2011;123(21):2344–52.
Goel K, Pack QR, Lahr B, Greason KL, Lopez-Jimenez F, Squires RW, et al. Cardiac rehabilitation is associated with reduced long-term mortality in patients undergoing combined heart valve and CABG surgery. Eur J Prev Cardiol. 2015;22(2):159–68.
Pack QR, Goel K, Lahr BD, Greason KL, Squires RW, Lopez-Jimenez F, et al. Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery: a community-based study. Circulation. 2013;128(6):590–7.
Suaya JA, Stason WB, Ades PA, Normand SLT, Shepard DS. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol. 2009;54(1):25–33.
Hannan AL, et al. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. Open Access J Sports Med. 2018;9:1–17.
Kotseva K, Wood D, de Bacquer D, EUROASPIRE investigators. Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey. Eur J Prev Cardiol. 2018;25(12):1242–51.
Blumenthal JA, Sherwood A, Babyak MA, Watkins LL, Smith PJ, Hoffman BM, et al. Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. J Am Coll Cardiol. 2012;60(12):1053–63.
Harrison AS, Doherty P. Does the mode of delivery in cardiac rehabilitation determine the extent of psychosocial health outcomes? Int J Cardiol. 2018;255:136–9.
Shah ND, et al. Long-term medication adherence after myocardial infarction: experience of a community. Am J Med. 2009;122(10):961 e7–13.
Ades PA, Pashkow FJ, Nestor JR. Cost-effectiveness of cardiac rehabilitation after myocardial infarction. J Cardpulm Rehabil. 1997;17(4):222–31.
Alter DA, Yu B, Bajaj RR, Oh PI. Relationship between cardiac rehabilitation participation and health service expenditures within a universal health care system. Mayo Clin Proc. 2017;92:500–11.
Amsterdam EA, Wenger NK, Brindis RG, Casey de Jr, Ganiats TG, Holmes DR Jr, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344–426.
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):2610–42.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124(23):e574–651.
O'Gara PT, Kushner FG, Ascheim DD, Casey de Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362–425.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810–52.
Suaya JA, Shepard DS, Normand SLT, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116(15):1653–62.
Beatty AL, Li S, Thomas L, Amsterdam EA, Alexander KP, Whooley MA. Trends in referral to cardiac rehabilitation after myocardial infarction: data from the National Cardiovascular Data Registry 2007 to 2012. J Am Coll Cardiol. 2014;63(23):2582–3.
• Beatty AL, et al. Geographic variation in cardiac rehabilitation participation in Medicare and Veterans Affairs populations: opportunity for improvement. Circulation. 2018;137(18):1899–908 Evidence from Medicare and the Veterans Affairs populations suggests that participation in cardiac rehabilitation continues to be very low, with considerable variability by geographic regions. This suggests that it is possible for low performing regions to improve, by following the methods used in the higher performing regions.
Doll JA, Hellkamp A, Ho PM, Kontos MC, Whooley MA, Peterson ED, et al. Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction. JAMA Intern Med. 2015;175(10):1700–2.
Dunlay SM, Witt BJ, Allison TG, Hayes SN, Weston SA, Koepsell E, et al. Barriers to participation in cardiac rehabilitation. Am Heart J. 2009;158(5):852–9.
•• Ades PA, et al. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clin Proc. 2017;92(2):234–42 This document is a critically important reference for all cardiac rehabilitation professionals and administrators. It reviews important system-based, evidence-supported strategies to help improve cardiac rehabilitation participation.
Bachmann JM, Duncan MS, Shah AS, Greevy RA Jr, Lindenfeld JA, Keteyian SJ, et al. Association of cardiac rehabilitation with decreased hospitalizations and mortality after ventricular assist device implantation. JACC Heart Fail. 2018;6(2):130–9.
Varnfield M, Karunanithi M, Lee CK, Honeyman E, Arnold D, Ding H, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart. 2014;100(22):1770–9.
Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004;44(5):988–96.
West RR, Jones DA, Henderson AH. Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction. Heart. 2012;98(8):637–44.
Doherty P, Lewin R. The RAMIT trial, a pragmatic RCT of cardiac rehabilitation versus usual care: what does it tell us? Heart. 2012;98(8):605–6.
Members BEC. RAMIT presents an outdated version of cardiac rehabilitation. Heart. 2012;98(8):672 author reply 673-4.
Almodhy M, Ingle L, Sandercock GR. Effects of exercise-based cardiac rehabilitation on cardiorespiratory fitness: a meta-analysis of UK studies. Int J Cardiol. 2016;221:644–51.
Abell B, Glasziou P, Hoffmann T. Reporting and replicating trials of exercise-based cardiac rehabilitation: do we know what the researchers actually did? Circ Cardiovasc Qual Outcomes. 2015;8(2):187–94.
Wewege MA, Ahn D, Yu J, Liou K, Keech A. High-intensity interval training for patients with cardiovascular disease-is it safe? A systematic review. J Am Heart Assoc. 2018;7(21):e009305.
Ellingsen O, Halle M, Conraads V, Støylen A, Dalen H, Delagardelle C, et al. High-intensity interval training in patients with heart failure with reduced ejection fraction. Circulation. 2017;135(9):839–49.
Guddeti RR, et al. Role of yoga in cardiac disease and rehabilitation. J Cardiopulm Rehabil Prev. 2018.
Liu T, Chan AWK, Liu YH, Taylor-Piliae RE. Effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being, and cardiovascular risk reduction among patients with coronary heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Nurs. 2018;17(4):368–83.
Salmoirago-Blotcher E, et al. Tai Chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc. 2017;6(10).
Thomas RJ, Beatty AL., Beckie TM, Brewer LC, Brown TM, Forman, DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA., Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. (in press).
Golbus JR, Nallamothu BK. Loss-framed financial incentives with a wearable device for secondary prevention of ischemic heart disease: stepping up to the challenge? J Am Heart Assoc. 2018;7(12).
•• Lee H, et al. Dedicated cardiac rehabilitation wearable sensor and its clinical potential. PLoS One. 2017;12(10):e0187108 New technology tools will help to expand cardiac rehabilitation services well beyond the walls of the cardiac rehabilitation center. Patients will be able to receive feedback and guidance potentially every hour of every day.
Gaalema DE, Savage PD, Rengo JL, Cutler AY, Higgins ST, Ades PA. Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients. Prev Med. 2016;92:47–50.
Ito K, Avorn J, Shrank WH, Toscano M, Spettel C, Brennan T, et al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes. 2015;8(3):252–9.
Pack QR, Johnson LL, Barr LM, Daniels SR, Wolter AD, Squires RW, et al. Improving cardiac rehabilitation attendance and completion through quality improvement activities and a motivational program. J Cardiopulm Rehabil Prev. 2013;33(3):153–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Prevention
Rights and permissions
About this article
Cite this article
Thomas, R.J., Huang, HH. Cardiac Rehabilitation for Secondary Prevention of Cardiovascular Disease: 2019 Update. Curr Treat Options Cardio Med 21, 56 (2019). https://doi.org/10.1007/s11936-019-0759-7
Published:
DOI: https://doi.org/10.1007/s11936-019-0759-7