Referral, Enrollment, and Delivery of Cardiac Rehabilitation/Secondary Prevention Programs at Clinical Centers and Beyond

Abstract

Each year, an estimated 785 000 Americans will suffer a new myocardial infarction (MI; heart attack), and nearly 470 000 will have a recurrent attack.1 Within 5 years of an initial MI, 15% of men and 22% of women 45 to 64 years of age and 22% of men and women >65 years of age will suffer a recurrent MI or fatal coronary heart disease (CHD).1 Given this high recurrence rate, preventing secondary cardiac events is an essential part of the care for patients with cardiovascular disease (CVD). Cardiac rehabilitation/secondary prevention programs (CR/SPPs) are medically supervised programs that help patients with CVD to recover more quickly after a cardiac event and to stay healthy. CR/SPPs are more than just diet and exercise programs; these programs offer a multifaceted and multidisciplinary approach to optimize the overall physical, mental, and social functioning of people with CVD. CR/SPPs include specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance with these behaviors, reduce disability, and promote an active lifestyle for patients with CVD.2 Comprehensive CR/SPPs consist of baseline patient assessment, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes mellitus, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training. Patients participating in CR/SPPs are also prescribed cardioprotective drugs that have evidence-based efficacy for secondary prevention. The goal of cardiac rehabilitation and secondary prevention is to stabilize, slow, or even reverse the progression of CVD, which in turn reduces the risk of a future cardiac event. The interventions provided by CR/SPPs are especially important because of the limited time available during the shortened hospital stays and brief outpatient physician visits now common in contemporary medical practice. There is ample evidence on the proven benefits of CR/SPPs on CHD risk factors …