Current role and future perspectives of cardiac rehabilitation in coronary heart disease

Abstract

Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

Keywords: Cardiac rehabilitation, Secondary prevention, Myocardial infarction, Ischaemic heart disease, Cardiovascular diseases

Core Tip: Ischaemic heart disease (IHD) is a leading cause of morbidity and mortality. Cardiac rehabilitation (CR) programmes have evolved over the years, as to provide comprehensive frameworks encompassing several domains of secondary prevention and forming an integral part of the contemporary management of individuals with IHD. Whilst this, the optimal application of these programmes, in diverse subsets of patients, remains an evolving and challenging field. In this review, we present a pragmatic overview on the current data concerning CR in IHD, while also discussing some of the caveats and future perspectives in this topic.