Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery

Abstract

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice.

A Review of Cardiac Rehabilitation Delivery Around the World

“…Contrary to some (but not all 20 ) guideline recommendations 16,18,15 that CR be directed by physicians however, these providers were only among the top three most frequent personnel in the Middle East and North Africa, Latin America and the Caribbean, Europe as well Central Asia (but not in East Asia, the Pacific, and North America). Also interestingly, in some regions physiotherapists were a main part of the team (n=17 of 21 papers reporting staff composition, e.g., Australia, England, Scotland, Northern Ireland, Wales, Denmark, Italy, Portugal, Spain, Mexico, Bahrain, Egypt, Qatar, UAE and Canada; e.g., 24,61,66,92 ), whereas in others, exercise specialists were more common (i.e., exercise physiologists, kinesiologists; n=7 of 21 papers reporting staff composition; North America, China and the Middle East; e.g., 24,93 ).…”

“…Regardless, the results herein for the first time characterize how CR is delivered in relation to established standards 13,14,18,27 .…”

Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease

“…The duration of the rehabilitation programme was consistent with the European Society of Cardiology guidelines (12). A physical examination and treadmill stress test were carried out before and after the rehabilitation cycle.…”

“…The study group consisted of 89 patients (mean age: 60.44±9.29 years) who were to be subjected to a cardiac rehabilitation programme, while the control group consisted of 35 patients (mean age: 61.43±8.81 years) who did not undergo cardiac rehabilitation. As the beneficial influence of cardiac rehabilitation has already been documented, no typical randomisation was performed (12). All patients were encouraged to enrol in rehabilitation, as preventing the subjects from participating in cardiac rehabilitation would have been unethical.…”

“…During general rehabilitation exercises, heart rate was continuously monitored using a Polar S720i heart rate monitor (0.2-Hz sampling rate) (Polar Electro Oy, Kempele, Finland). Cardiac rehabilitation was performed as per the recommendations of the European Society of Cardiology (12, 15). The control group, which was not subjected to cardiac rehabilitation, received, as part of their health-promoting education, information about the importance of maintaining an active lifestyle, with individual recommendations concerning the type, intensity and amount of leisure-time physical activity.…”