Outpatient Cardiac Rehabilitation Phases
Phases 2 and 3 of cardiac rehabilitation are performed in the outpatient setting. 1
Phase Structure
According to the AACVPR/ACC/AHA guidelines, cardiac rehabilitation is divided into three distinct phases based on setting and timing 1:
Phase 1 (Inpatient CR)
- Delivered to hospitalized patients following an acute cardiovascular event (MI, acute coronary syndrome, cardiac surgery) 1
- This is the only phase that is NOT outpatient 1
Phase 2 (Early Outpatient CR)
- Performed in the outpatient setting early after a cardiovascular event 1
- Typically begins within the first 3 to 6 months after the cardiac event but may continue for up to 1 year 1
- This phase has been most widely documented to reduce cardiovascular mortality among participants 1
- Traditionally requires direct physician supervision with the physician immediately available in the exercise area 1
- Can be delivered through center-based, home-based, telephone-based, or Internet-based programs 1, 2
Phase 3/4 (Long-term Outpatient CR)
- Provides longer-term outpatient delivery of preventive and rehabilitative services 1
- Represents a lifelong maintenance phase beginning 3 to 6 months after the cardiac event 3
- Involves individualized surveillance and monitoring schedules 3
- Has demonstrated prolonged survival benefits 3
Key Clinical Points
Both Phase 2 and Phase 3 are outpatient phases, with Phase 2 being the early intensive period and Phase 3 representing long-term maintenance 1. The distinction is primarily temporal rather than based on setting—both occur outside the hospital environment 1.
Home-based cardiac rehabilitation (HBCR) represents an alternative delivery model for outpatient phases that relies on remote coaching with indirect exercise supervision, provided mostly or entirely outside traditional center-based settings 2. This approach may be reasonable for selected clinically stable low- to moderate-risk patients who cannot attend traditional center-based programs 2.