Outpatient cardiac rehabilitation: the Austrian model

Abstract

Over the past decades undisputable evidence has accumulated identifying the panoply of beneficial effects of exercise training, smoking cessation, blood pressure lowering, glycaemic and lipid control, as well as psycho-social interventions on cardiovascular risk factors, the well-being, morbidity and mortality of patients with cardiac diseases with or without acute events. Nevertheless, despite all the evidence, insurance companies are more than hesitant to provide patients with an adequate infrastructure to allow outpatient cardiac rehabilitation in their community. Whereas some countries still favour in-hospital rehabilitation, others are on the verge of introducing cardiac rehabilitation for the first time. Thanks to the efforts of the Working Group of Outpatient Cardiac Rehabilitation of the Austrian Cardiac Society, detailed guidelines for outpatient cardiac rehabilitation have been introduced, which not only include aims, contents and duration of outpatient cardiac rehabilitation, but also requirements for staff, quality of care and infrastructure. As a result cardiac rehabilitation in Austria is currently undergoing a transition process from exclusive in-hospital cardiac rehabilitation to a more open approach of granting patients a choice between in-hospital and outpatient rehabilitation. Experience gained appears relevant to a great number of colleagues in many countries Europe - as well as worldwide. Since these guidelines were and still are the basis for implementing outpatient cardiac rehabilitation, they are presented in great detail, so that they may either be applied as is or simply stimulate discussion.

A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?

“…26 Exercise and functional assessment Considerable variation exists in the specificity and technical skill of exercise testing recommended in cardiac rehabilitation guidelines internationally, as shown in Tables 1 and 2. An ECG-monitored exercise stress test is recommended by the AHA and AACVPR, 18,19 CACR 20 and EACPR.…”

“…40 The low number of sessions detailed in some national guidelines is balanced by the inclusion of an expectation that patients will complete a minimum of 30 minutes of moderateintensity, home-based physical activity on most days of the week to supplement their supervised training sessions. 4,19,20,22,26,29,30,34 Resistance training. Detailed recommendations for resistance training are not routinely included in cardiac rehabilitation guidelines to the same level as aerobic exercise prescription (Tables 1 and 2).…”

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting?

“…[21][22][23][24][25] This is manifested in current guidelines and position papers from all the major cardiac societies. 7,12,26,27 Despite the fact that all modifiable risk factors should be considered to normalize the risk factor profile, battling endemic physical inactivity seems especially worthwhile. Indeed, physical inactivity has a high prevalence in the adult population worldwide (>30%), with proportions ranging from 17% in Southeast Asia to ≈43% in the Americas and the eastern Mediterranean.…”

“…The core components of this rehabilitation model have been built around current literature and guidelines. 26 Currently, we are in the midst of analyzing data of some 5500 consecutive patients, which will provide an even deeper and more complete insight.…”

“…With the understanding that longer programs are needed to achieve long-term lifestyle changes, the Austrian Working Group of Outpatient Cardiac Prevention and Rehabilitation has previously published guidelines on outpatient cardiac rehabilitation, 26 and in a subsequent analysis, some 1500 consecutive patients in a nationwide registry were assessed. 33 The Austrian model constitutes a phase II (60 hours over 6 weeks) and subsequent phase III (up to 100 hours over 6-12 months) that give patients ample time not only to improve their physical work capacity but also to translate what they have learned in classes on lifestyle changes to their daily routine.…”