Top Things to Know: Core Components of Cardiac Rehabilitation Programs: 2024 Update
Prepared by Prepared by: Todd Brown, MD, MSPH, FAHA, FACC, MAACVPR, University of Alabama at Birmingham Heersink School of Medicine, Department of Medicine, Division of Cardiovascular Disease
- Cardiac rehabilitation (CR) is indicated in a broad population of patients with cardiovascular disease including those with a myocardial infarction in the last 12 months; those who have undergone coronary artery angioplasty or stenting, coronary artery bypass graft surgery, heart valve repair or replacement, or heart or heart-lung transplantation; and those with stable angina or heart failure.
- CR programs consist of a multidisciplinary team of clinicians, which may include physicians, nurses, clinical exercise physiologists, behavioral health experts, dietitians, physical and respiratory therapists, and others who collaborate to deliver these services.
- CR programs are mandated to include physician-prescribed exercise, cardiac risk factor modification, psychosocial assessment, and outcomes assessment.
- In this document, we update the core components of CR to include: patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, physical activity counseling, and program quality.
- CR reduces mortality, improves the quality of life of patients with cardiovascular disease, and its utilization is supported by American College of Cardiology/American Heart Association performance measures and numerous clinical practice guidelines but is grossly underutilized.
- Historically, CR has been provided almost exclusively in-person in a hospital or physician office setting. However, CR programs and patients are increasingly seeking new methods to deliver CR sessions.
- Virtual (synchronous) sessions are conducted by clinicians working in CR programs who interact with patients for the entire duration of the session using real-time audio-visual communications technology; whereas, during remote (asynchronous) sessions, there is no real-time interaction.
- There is evidence to suggest these alternative delivery models have similar efficacy and safety as traditional in-person CR in improving cardiovascular disease risk factors, mortality, and health-related quality of life, at least in patients at low to moderate risk.
- Hybrid models that incorporate multiple delivery methods have the potential to bolster equity in CR participation by offering multiple options to meet the individual needs of diverse populations.
- The adoption of novel models of delivery must not change the fundamental therapeutic foundation in what is delivered. CR is a medically supervised secondary prevention program with a physician medical director, day-to-day medical supervision by a physician or non-physician practitioner, and core components, all of which must be included for a program to be classified as CR.
Citation
Brown TM, Pack QR, Aberegg E, Brewer LC, Ford YR, Forman DE, Gathright EC, Khadanga S, Ozemek C, Thomas RJ; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Core components of cardiacrehabilitation programs: 2024 update: a scientific statement from the American Heart Association and theAmerican Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. Published online September 24, 2024. doi: 10.1161/CIR.0000000000001289