Referral, Enrollment, and Delivery of Cardiac Rehabilitation/Secondary Prevention Programs at Clinical Centers and Beyond
Authors: Gary J. Balady, Philip A. Ades, Vera A. Bittner, Barry A. Franklin, Neil F. Gordon, Randal J. Thomas, Gordon F. Tomaselli, Clyde W. Yancy
Journal: Circulation (2011)

E ach year, an estimated 785 000 Americans will suffer a new myocardial infarction (MI; heart attack), and nearly 470 000 will have a recurrent attack. 1 Within 5 years of an initial MI, 15% of men and 22% of women 45 to 64 years of age and 22% of men and women Ͼ65 years of age will suffer a recurrent MI or fatal coronary heart disease (CHD). 1 Given this high recurrence rate, preventing secondary cardiac events is an essential part of the care for patients with cardiovascular disease (CVD).Cardiac rehabilitation/secondary prevention programs (CR/SPPs) are medically supervised programs that help patients with CVD to recover more quickly after a cardiac event and to stay healthy.CR/SPPs are more than just diet and exercise programs; these programs offer a multifaceted and multidisciplinary approach to optimize the overall physical, mental, and social functioning of people with CVD.CR/SPPs include specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance with these behaviors, reduce disability, and promote an active lifestyle for patients with CVD. 2 Comprehensive CR/SPPs consist of baseline patient assessment, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes mellitus, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training.Patients participating in CR/SPPs are also prescribed cardioprotective drugs that have evidence-based efficacy for secondary prevention.The goal of cardiac rehabilitation and secondary prevention is to stabilize, slow, or even reverse the progression of CVD, which in turn reduces the risk of a future cardiac event.The interventions provided by CR/SPPs are especially important because of the limited time available during the shortened hospital stays and brief outpatient physician visits now common in contemporary medical practice.There is ample evidence on the proven benefits of CR/SPPs on CHD risk factors and exercise capacity. 3 Moreover, recent data demonstrate that participation in CR/SPP is associated with a reduction in mortality after percutaneous coronary interventions 4 and with a dosedependent reduction in both mortality and recurrent MI for those patients with stable angina or patients after MI or coronary artery bypass surgery. 5Given the significant benefits that CR/SPPs bring to CVD prevention, every recent major evidence-based guideline from the American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF) about the management and prevention of CHD provides a Class I-level recommendation (ie, procedure/treatment should be performed/ administered) for referral to a CR/SPP 6 for those patients with recent MI or acute coronary syndrome, chronic stable angina, heart failure, or after coronary artery bypass surgery or percutaneous coronary intervention.CR/SPPs are also indicated for those patients after valve surgery or cardiac transplantation. 6e American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.