Abstract
The American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation recognize that all cardiac rehabilitation/secondary prevention programs should contain specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance to these behaviors, reduce disability, and promote an active lifestyle for patients with cardiovascular disease. This update to the previous statement presents current information on the evaluation, interventions, and expected outcomes in each of the core components of cardiac rehabilitation/secondary prevention programs, in agreement with the 2006 update of the American Heart Association/American College of Cardiology Secondary Prevention Guidelines, including baseline patient assessment, nutritional counseling, risk factor management (lipids, blood pressure, weight, diabetes mellitus, and smoking), psychosocial interventions, and physical activity counseling and exercise training.
Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with cardiovascular disease1,2 and as such are recommended as useful and effective (Class I) by the American Heart Association (AHA) and the American College of Cardiology in the treatment of patients with coronary artery disease3–5 and chronic heart failure.6 Consensus statements from the American Heart Association,1 the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR),7 and the Agency for Health Care Policy and Research2 conclude that cardiac rehabilitation programs should offer a multifaceted and multidisciplinary approach to overall cardiovascular risk reduction and that programs that consist of exercise training alone are not considered cardiac rehabilitation. The AHA and the AACVPR recognize that all cardiac rehabilitation/secondary prevention programs should contain 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 cardiovascular disease.8
This update to the previous statement8 aims to present current information on the evaluation, interventions, and expected outcomes in each of the core components of cardiac rehabilitation/secondary prevention programs in agreement with the 2006 update of the AHA/American College of Cardiology (ACC) secondary prevention guidelines,9 including baseline patient assessment, nutritional counseling, risk factor management (lipids, blood pressure, weight, diabetes mellitus, and smoking), psychosocial interventions, and physical activity counseling and exercise training (Tables 1 and 2⇓⇓⇓⇓⇓).2,7,9–25 The most notable updates in the present statement are the changes in lipid goals and strategies to attain them and a new emphasis on ensuring that patients are taking the appropriate medications that have been shown to be of substantial benefit in reducing subsequent adverse cardiovascular events. Inherent to these recommendations is the understanding that successful risk factor modification and the maintenance of a physically active lifestyle is a lifelong process. Hence, incorporation of strategies to optimize patient adherence to lifestyle and pharmacological therapies is integral to the attainment of sustained benefits. It is essential to the success of any program that each of these interventions is performed in concert with the patient’s primary care provider and/or cardiologist, who will subsequently supervise and refine these interventions over the long term.10 These recommendations are intended to assist cardiac rehabilitation staff in the design and development of programs and to assist healthcare providers, insurers and policy makers, and consumers in the recognition of the comprehensive nature of such programs. In turn, insurance providers and third-party payers should provide adequate reimbursement for cardiac rehabilitation/secondary prevention programs such that comprehensive interventions delivered by a multidisciplinary team of professionals can be sustained. It is not the intent of this statement to promote a rote approach or homogeneity among programs but rather to foster a foundation of services on which each program can establish its own specific strengths and identity and effectively attain outcome goals for its target population. Presently, these core components are an integral part of the national program certification process established by the AACVPR (http://www.aacvpr.org/certification/). As such, programs certified by the AACVPR are recognized as meeting essential standards of care in keeping with the contemporary definition of cardiac rehabilitation as a secondary prevention program. The AHA and AACVPR encourage all cardiac rehabilitation/secondary prevention programs to meet the standards for AACVPR program certification.
TABLE 1. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs: Patient Assessment, Nutritional Counseling, and Weight Management
TABLE 1. Continued
TABLE 2. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs: Blood Pressure Management, Lipid Management, Diabetes Management, Tobacco Cessation, Psychosocial Management, Physical Activity Counseling, and Exercise Training
TABLE 2. Continued
TABLE 2. Continued
TABLE 2. Continued
Comprehensive and detailed guidelines on cardiac rehabilitation/secondary prevention programs have been published by the AACVPR7 and endorsed by the AHA. Detailed guidelines on specific risk factor modification are also available.9,11–20 Specific details on management of patients with heart failure, valvular disease, arrhythmias, and other cardiovascular diagnoses in such programs are beyond the scope of this document and can be found in the AACVPR guidelines.7
Footnotes
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The American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
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This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 11, 2006, and by the American Association of Cardiovascular and Pulmonary Rehabilitation on June 22, 2006.
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This article has been copublished in the May/June issue of the Journal of Cardiopulmonary Rehabilitation.
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Copies: This document is available on the World Wide Web sites of the American Heart Association (www.americanheart.org) and of the American Association of Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org). A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0394. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.
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Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifier=3023366.
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Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?identifier=4431. A link to the “Permission Request Form” appears on the right side of the page.
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