Current Concepts in Cardiac Rehabilitation Medical Considerations and Outcomes Evaluations

Journal of Clinical and Basic Cardiology 2001; 4 (3): 211-219

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Keywords: Endpunkt,  kardiale Rehabilitation,  Kardiologie,  Konzept,  Praxis,  cardiac rehabilitation,  cardiology,  concepts,  Outcome,  practice

The concept of cardiac rehabilitation and secondary prevention can be defined as the effort toward cardiovascular risk factor reduction designed to lessen the chance of a subsequent cardiac event and to slow and perhaps stop the progression of the cardiovascular disease process. A multifactorial and multidisciplinary approach is imperative nowadays in order to meet the challenges of reducing the progression of CAD, the rate of cardiovascular events and of improving the quality of life in patients with proven CAD. A long-term comprehensive cardiac care program involves a close follow up, risk factor modification, patient education, and psychological guidance. Contemporary cardiac rehabilitation programs should incorporate tailored modifications and motivational strategies to enhance participant interest and adherence. Individual cardiac rehabilitation and exercise training studies have demonstrated improved exercise capacity, reduced various CAD risk factors, improved health-related quality of life and reduced subsequent hospitalisation costs. However, the findings in three meta-analyses of cardiac rehabilitation showed that exercise-based cardiac rehabilitation is effective in reducing cardiac deaths but there is insufficient evidence to make conclusions on benefit in terms of risk factors and health-related quality of life. Unfortunately, patients who could have benefited most were in fact excluded from the randomized controlled trials on the basis of age, gender, or co-morbidity. There is little evidence on which to base a choice between exercise-only and comprehensive cardiac rehabilitation, suggesting that it would be rational to consider both cost and local access to available services to determine practice.