What is Cardiac Rehabilitation?
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease, reducing morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery. 1
Core Components of Cardiac Rehabilitation
Cardiac rehabilitation is a complex, multicomponent intervention that includes:
Exercise Training and Physical Activity Promotion
- Physician-prescribed exercise tailored to the patient's condition
- Aerobic exercise training
- Strength training
- Physical activity counseling for everyday life
Cardiovascular Risk Factor Management
- Comprehensive assessment of cardiac risk factors
- Management of hypertension, diabetes, and lipid disorders
- Weight management and body composition assessment
- Smoking cessation support
Nutritional Counseling
- Dietary assessment and personalized nutrition plans
- Education on heart-healthy eating patterns
Psychosocial Management
- Assessment of psychological well-being
- Stress management techniques
- Support for depression, anxiety, and social isolation
Patient Education
- Education on cardiovascular disease processes
- Self-management strategies
- Medication adherence
Program Quality
- Monitoring of processes and outcomes
- Ongoing quality improvement 1
Eligible Patient Populations
Cardiac rehabilitation is recommended for patients with:
- Acute myocardial infarction within the past 12 months
- Coronary artery bypass graft surgery
- Coronary angioplasty or stenting
- Heart valve repair or replacement
- Heart or heart-lung transplantation
- Stable angina
- Stable chronic heart failure 1
Delivery Models
Center-Based Cardiac Rehabilitation (CBCR)
- Traditional model provided in a medically supervised facility
- Requires on-site supervision by healthcare professionals
- Structured exercise sessions with direct monitoring
Home-Based Cardiac Rehabilitation (HBCR)
- Relies on remote coaching with indirect exercise supervision
- Provided mostly or entirely outside traditional center-based settings
- May be a reasonable option for selected clinically stable low- to moderate-risk patients who cannot attend traditional center-based programs 1
Virtual/Hybrid Programs
- Emerging delivery model using technology to provide remote services
- Can help overcome barriers to traditional participation
- Particularly valuable during situations like the COVID-19 pandemic 1
Benefits of Cardiac Rehabilitation
- Reduced hospital readmissions
- Decreased secondary cardiovascular events
- Lower mortality rates
- Improved functional capacity
- Enhanced quality of life
- Better psychological well-being 1
Challenges and Barriers
Despite strong recommendations in clinical guidelines, cardiac rehabilitation remains significantly underutilized:
- Only about 20-30% of eligible patients participate in CR programs 2
- Participation is especially low for Medicare beneficiaries, veterans, women, older adults, and individuals from underserved populations 1
- Barriers include geographical accessibility, scheduling conflicts, transportation issues, and cost 3
Future Directions
- Expanding home-based and technology-based models to improve accessibility
- Addressing the needs of patients with multiple chronic conditions
- Strengthening evidence for CR in other cardiac conditions (heart failure with preserved ejection fraction, atrial fibrillation, congenital heart disease)
- Developing sustainable and affordable delivery models for all income settings 1
Cardiac rehabilitation represents a critical component in the continuum of care for patients with cardiovascular disease, with a Class IA recommendation from major cardiovascular societies. Efforts to increase participation through innovative delivery models and addressing barriers are essential to maximize its proven benefits for cardiovascular health outcomes.