Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases

Abstract

Cardiovascular diseases are the most common causes of mortality worldwide. They are frequently the reasons for patient hospitalization, their incapability for work, and disability. These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families. It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle, and so modification of the latter is an essential component of both primary and secondary prevention. Cardiac rehabilitation (CR) represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity. This review presents an overview of basic information on CR with a focus on current trends, such as the issue of the various training modalities, utilization, and barriers to it or the use of telemedicine technologies. Appropriate attention should be devoted to these domains, as CR continues evolving as an effective and readily available intervention in the future.

Current role and future perspectives of cardiac rehabilitation in coronary heart disease

“…This latter issue was also reported on a study assessing CR availability worldwide, showing important differences according to location[ 13 ]. Though outside the scope of the present report, several factors encompassing patient-related, physician-related, and system-related barriers can affect CR referral as well as completion[ 5 , 14 , 82 - 84 ] (Table 1 ). As such, and as reviewed by Chindhy et al [ 83 ], strategies directed at each of these components should be the focus of further tailoring, as to allow increased CR uptake.…”

“…Strategies such as physician and patient education on the benefits of CR, automatic patient referral, flexible hours as well as optimization of expense coverage and early appointments after hospital discharge have been among some of the modalities postulated as to tackle some of these barriers[ 14 , 83 , 85 ]. Additionally, the potential utilization of alternative modalities should also be reflected upon, to mitigate some of these barriers[ 82 , 86 - 88 ]. Interestingly, and as discussed below, home-based CR (HBCR) as well as the incorporation of different technologies (such as sensors) could also be of interest, as to address some of these gaps[ 82 , 83 , 89 , 90 ].…”

“…Additionally, the potential utilization of alternative modalities should also be reflected upon, to mitigate some of these barriers[ 82 , 86 - 88 ]. Interestingly, and as discussed below, home-based CR (HBCR) as well as the incorporation of different technologies (such as sensors) could also be of interest, as to address some of these gaps[ 82 , 83 , 89 , 90 ]. As detailed in a statement concerning HBCR, this could be an option to overcome several barriers to CR such as scheduling, access, and transportation issues, as well as enrolment delays, though pitfalls such as less intensive training, monitoring and safety concerns related to higher risk patients have also been noted as some of its potential disadvantages[ 89 , 91 , 92 ].…”

The Efficacy and Safety of Phase I Cardiac Rehabilitation in Patients Hospitalized in Cardiac Intensive Care Unit With Acute Decompensated Heart Failure: A Study Protocol for a Randomized, Controlled, Clinical Trial

“…Impaired exercise capacity in patients with ADHF has detrimental effects on the health-related quality of life (QOL) and adverse outcomes ( 7 ). In recent decades, the physiological basis of exercise benefits was acknowledged, which led to the development of cardiac rehabilitation (CR) ( 8 ). There is solid evidence from numerous trials and meta-analyses that exercise-based CR improves cardiorespiratory function, exercise tolerance and QOL in patients with chronic HF ( 9 , 10 ).…”

Is the Training Intensity in Phase Two Cardiovascular Rehabilitation Different in Telehealth versus Outpatient Rehabilitation?

“…However, implementation of telehealth CR services in clinical medicine avoids specific concerns, including legal clarity over intervention responsibilities, costs, and training adherence as well as the issue of compliance with training exercise intensity in the home environment [ 25 ]. Therefore, the research question of our study was: Is the training intensity in telehealth versus outpatient phase II CR different?…”