Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease, which includes components of health education, advice on. Gwinnett Medical Centers cardiology department has been providing cardiac and vascular care for more than 20 years and has a nationally accredited Chest Pain Center. Cardiac rehabilitation The BMJHasnain M Dalal, honorary clinical associate professor. Patrick Doherty, chair in cardiovascular health, director of the National Audit of Cardiac Rehabilitation, deputy head of department research2, Rod S Taylor, chair of health services research, academic lead for Exeter Clinical Trials Support Network, NIHR senior investigator. University of Exeter Medical School primary care, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3. HD, UK2. Department of Health Sciences, University of York, York YO1. DD, UK3. Institute of Health Research, University of Exeter Medical School, Exeter EX1 2. LU, UKCorrespondence to H M Dalal hmdalalatdoctors. The bottom line. Globally, the prevalence of coronary heart disease and heart failure is increasing, and there is some evidence of the health benefits of cardiac rehabilitation. Effective implementation of cardiac rehabilitation after acute coronary syndrome, coronary revascularisation, and heart failure has remained suboptimal, with overall participation rates lt 5. International guidelines now recommend that cardiac rehabilitation programmes include health education and psychological counselling. Patients should be offered a choice of community based and home based cardiac rehabilitation programmes to fit their needs and preferences. Clinicians should endorse cardiac rehabilitation for patients with a recent diagnosis of coronary heart disease or heart failure. Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease, which includes components of health education, advice on cardiovascular risk reduction, physical activity and stress management. Evidence that cardiac rehabilitation reduces mortality, morbidity, unplanned hospital admissions in addition to improvements in exercise capacity, quality of life and psychological well being is increasing, and it is now recommended in international guidelines. This review focuses on what cardiac rehabilitation is and the evidence of its benefit and effects on cardiovascular mortality, morbidity and quality of life. Sources and selection criteria. RST is a member of the Cochrane Heart Group and has led and conducted several systematic reviews of cardiac rehabilitation. We searched the Cochrane database www. We identified current national and international clinical guidelines based on systematic reviews and meta analyses. We referred to the National Audit of Cardiac Rehabilitation annual report, which was led by PD, and the British Heart Foundations website for statistics on coronary heart disease in the UK. We also consulted recent review articles from the UK, US, Canada, and Australia. We have included topics that would be of interest to hospital doctors and general practitioners based on a previous review coauthored by HMD and also the level 1 evidence provided by the Cochrane reviews. RSE%20Plasma%20Flow%20(ml-100ml-min).0001.png' alt='Musc Cardiac Perfusion Program' title='Musc Cardiac Perfusion Program' />We also used our personal reference collections. Why is cardiac rehabilitation important Although mortality from coronary heart disease has fallen over recent decades, annually it still claims an estimated 1. Europe,7 and 7. 85 0. US. 8 In the UK, around 1. With improved survival and an aging population, the number of people living with coronary heart disease in the UK has increased to an estimated 2. What is cardiac rehabilitation and who should get it Various organisations and national bodies have defined cardiac rehabilitation, which is encompassed by Cardiac rehabilitation and secondary prevention services are comprehensive, long term programmes involving medical evaluation, prescribed exercise, cardiac risk factor modification, education, and counselling. These programmes are designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or re infarction, control cardiac symptoms, stabilise or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients. Although exercise training is a core component, current practice guidelines consistently recommend comprehensive rehabilitation programmes that should include other components to optimise cardiovascular risk reduction, foster healthy behaviours and compliance to these behaviours, reduce disability, and promote an active lifestyle. The National Institute for Health and Care Excellence NICE, Department of Health, British Association for Cardiovascular Prevention and Rehabilitation BACPR, and wider European guidelines agree that the patient groups listed in box 1 will benefit from cardiac rehabilitation. Box 1 Patient groups who benefit from cardiac rehabilitationPatients with acute coronary syndromeincluding ST elevation myocardial infarction, non ST elevation myocardial infarction, and unstable anginaand all patients undergoing reperfusion such as coronary artery bypass surgery, primary percutaneous coronary intervention, and percutaneous coronary interventionPatients with newly diagnosed chronic heart failure and chronic heart failure with a step change in clinical presentation. Patients with heart transplant and ventricular assist device. Cardiac Perfusion Programs' title='Cardiac Perfusion Programs' />Patients who have undergone surgery for implantation of intra cardiac defibrillator or cardiac resynchronisation therapy for reasons other than acute coronary syndrome and heart failure. Windows Xp Home Edition Sp3 Pt-Pt Iso. Patients with heart valve replacements for reasons other than acute coronary syndrome and heart failure. Patients with a confirmed diagnosis of exertional anginaccording to NICE, Department of Health, BACPR, and European guidelines. Historically, cardiac rehabilitation in the UK, US, and most European countries has been delivered to groups of patients in healthcare or community centres. Recent guidance from the UK Department of Health. Fig 1 BACPR standards pathway, showing a patients journey through cardiac rehabilitation reproduced with permission from BACPR1. Tactics Ogre Art Works Book here. CRcardiac rehabilitation Formal rehabilitation programmes vary in intensity and duration. The European guide for patients with established cardiac disease provides a full review of the impact of the mode and dose of exercise based cardiac rehabilitation. In the UK, formal rehabilitation is predominantly provided to supervised groups in outpatient hospital clinics or community centres, starting 24 weeks after percutaneous coronary intervention or myocardial infarction and usually 46 weeks after cardiac surgery. The BACPR standard recommends delivery of the seven core components of cardiac rehabilitation after clinical assessment fig 2. Programmes are typically delivered by specialist nurses or physiotherapists supported by exercise therapists, although ideally an integrated multidisciplinary team led by an experienced clinician with a special interest in cardiac rehabilitation should deliver the programme BACPR standard 2, box 2. Most programmes involve weekly attendance at group sessions for an average of 5. SD 3. 6 days or approximately 8 weeks. Centre based sessions involve graduated exercise training, education covering coronary risk factors and diet, common cardiac misconceptions, preventative medication, and stress management. Ideally, patients should be given information about the cardiac event and lifestyle advice, including the importance of smoking cessation if appropriate, healthy diet, and physical activity to encourage progressive mobilisation.