Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: An AHA Scientific Statement

Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: An American Heart Association Scientific Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Coun
Arthur S. Leon et al.
This article updates the American Heart Association (AHA) 1994 scientific statement on cardiac rehabilitation. It provides a review of the recommended components of optimal rehabilitation/secondary prevention programs, ways to deliver these services, recommended future research directions, and the rationale for these recommendations, with emphasis on the exercise training component. Secondary prevention is an essential part of the contemporary care of the patient with cardiovascular disease (CVD). The term cardiac rehabilitation refers to coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality. As such, cardiac rehabilitation/secondary prevention programs provide an important and efficient venue in which to deliver effective preventive care. In 1994, the AHA declared that cardiac rehabilitation should not be limited to an exercise training program but also should include multifaceted strategies aimed at reducing modifiable risk factors for CVD. Since then, detailed guidelines have been published that clearly specify each of the core components of cardiac rehabilitation/secondary prevention programs, along with information about the evaluation, intervention, and expected outcomes in each area. Thus, cardiac rehabilitation/secondary prevention programs currently include baseline patient assessments, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training, in addition to the appropriate use of cardioprotective drugs that have evidence-based efficacy for secondary prevention. Candidates for cardiac rehabilitation services historically were patients who recently had had a myocardial infarction or had undergone coronary artery bypass graft surgery, but candidacy has been broadened to include patients who have undergone percutaneous coronary interventions; are heart transplantation candidates or recipients; or have stable chronic heart failure, peripheral arterial disease with claudication, or other forms of CVD. In addition, patients who have undergone other cardiac surgical procedures, such as those with valvular heart disease, also may be eligible.
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