The role of cardiac rehabilitation in improving cardiovascular outcomes - PubMed (original) (raw)

Review

The role of cardiac rehabilitation in improving cardiovascular outcomes

Rod S Taylor et al. Nat Rev Cardiol. 2022 Mar.

Abstract

Cardiac rehabilitation is a complex intervention that seeks to improve the functional capacity, wellbeing and health-related quality of life of patients with heart disease. A substantive evidence base supports cardiac rehabilitation as a clinically effective and cost-effective intervention for patients with acute coronary syndrome or heart failure with reduced ejection fraction and after coronary revascularization. In this Review, we discuss the major contemporary challenges that face cardiac rehabilitation. Despite the strong recommendation in current clinical guidelines for the referral of these patient groups, global access to cardiac rehabilitation remains poor. The COVID-19 pandemic has contributed to a further reduction in access to cardiac rehabilitation. An increasing body of evidence supports home-based and technology-based models of cardiac rehabilitation as alternatives or adjuncts to traditional centre-based programmes, especially in low-income and middle-income countries, in which cardiac rehabilitation services are scarce, and scalable and affordable models are much needed. Future approaches to the delivery of cardiac rehabilitation need to align with the growing multimorbidity of an ageing population and cater to the needs of the increasing numbers of patients with cardiac disease who present with two or more chronic diseases. Future research priorities include strengthening the evidence base for cardiac rehabilitation in other indications, including heart failure with preserved ejection fraction, atrial fibrillation and congenital heart disease and after valve surgery or heart transplantation, and evaluation of the implementation of sustainable and affordable models of delivery that can improve access to cardiac rehabilitation in all income settings.

© 2021. Springer Nature Limited.

PubMed Disclaimer

Conflict of interest statement

R.S.T. is a member of the ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP) Science Committee 2020–2022 and lead investigator for the following ongoing funded projects: ‘Implementation of an evidence-based cardiac rehabilitation home programme for heart failure patients and their caregivers in Scotland: SCOT:REACH-HF project’, funded by Heart Research UK; ‘A randomized controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Study’, funded by NIHR HTA Programme (NIHR130487). H.M.D. is a co-opted member of the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) and a co-lead for the ongoing funded research projects: ‘D REACH-HF: Digital Rehabilitation Enablement in Chronic Heart Failure’, funded by the British Heart Foundation, Hope for Hearts fund’; ‘Extending the reach and implementation of the successful REACH-HF programme with a digitally delivered training programme’, funded by NIHR Programme Development Grant (NIHR202040). S.J.D.M. is a researcher on the following ongoing funded research projects: ‘D REACH-HF: Digital Rehabilitation Enablement in Chronic Heart Failure’, funded by the British Heart Foundation, Hope for Hearts fund’; ‘Extending the reach and implementation of the successful REACH-HF programme with a digitally delivered training programme’, funded by NIHR Programme Development Grant (NIHR202040).

Figures

Fig. 1

Fig. 1. Components of comprehensive cardiac rehabilitation.

A schematic summary of the major components of comprehensive cardiac rehabilitation. Adapted by permission from BMJ Publishing Group Limited. [Advances in rehabilitation for chronic diseases: improving health outcomes and function. Richardson C.R., Franklin B., Moy M.L., Jackson E.A., 365, l2191, 2019].

Fig. 2

Fig. 2. Cardiac rehabilitation and all-cause mortality in patients with coronary heart disease: 1970–2020.

Meta-regression analysis of the treatment effect of cardiac rehabilitation on all-cause mortality over time in patients with coronary heart disease. The area of each data point is inversely related to the standard error of log relative risk (RR). The absence of an improvement in the effect of cardiac rehabilitation on all-cause mortality over the past 2–3 decades might reflect the evolution of usual care and the introduction of life-saving therapies, including thrombolysis and secondary prevention drugs.

Fig. 3

Fig. 3. Global incidence of ischaemic heart disease and availability of cardiac rehabilitation.

a | Age-standardized incidence of ischaemic heart disease. b | Total number of cardiac rehabilitation (CR) programmes per country. CR is available in only approximately half of the countries of the world and, in broad terms, the geographical distribution of CR is negatively correlated with the incidence of ischaemic heart disease. Data from ref..

Similar articles

Cited by

References

    1. Richardson CR, Franklin B, Moy ML, Jackson EA. Advances in rehabilitation for chronic diseases: improving health outcomes and function. BMJ. 2019;365:l2191. - PubMed
    1. Dempster M, Donnelly M. Measuring the health related quality of life of people with ischaemic heart disease. Heart. 2000;83:641–644. - PMC - PubMed
    1. Taylor R, Dibben G, Faulkner J, Dalal H. More evidence of cardiac rehabilitation: need to consider patient quality of life. Can. J. Cardiol. 2021 doi: 10.1016/j.cjca.2021.01.012. - DOI - PubMed
    1. Cook R, Davidson P, Martin R, et al. Cardiac rehabilitation for heart failure can improve quality of life and fitness. BMJ. 2019;367:l5456. - PubMed
    1. Ambrosetti M, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur. J. Prev. Cardiol. 2021;28:460–495. - PubMed

Publication types

MeSH terms

Grants and funding

LinkOut - more resources