Cardiac Rehabilitation
Contents. #Introduction · #Definition · #Key Concepts · #Epidemiology and Access · #Indications and Reimbursement · #Programme Structure and Phases · #Core Components · #Exercise Prescription · #Delivery Models · #Special Populations · #Rehabilitation in Heart Failure · #Rationale and Evidence · #Contradictions / Open Questions · #Connections · #Sources
Detailed pages. concepts/Cardiac-Rehabilitation-HF
Introduction
Cardiac rehabilitation is a supervised, multidisciplinary secondary-prevention service built around exercise training. It is recommended far more widely than it is reimbursed, and reimbursed far more widely than it is delivered.
- What it is. In US statute CR requires a physician medical director, day-to-day practitioner supervision, and every core component delivered through an individualised treatment plan updated every 30 days. ESC 2026 defines it more broadly as a multimodal, patient-centred intervention across Phases 0–III, and drops the "exercise-based" and "comprehensive" qualifiers rather than renaming the field. (sources/cardiac-rehab-aha-2024, rating: very high; sources/CRP-ESC-2026, rating: very high)
- The dose floor. Whatever the mode of delivery, ESC 2026 sets a minimum of 24 sessions over 12 weeks, typically two per week. (sources/CRP-ESC-2026)
- It is grossly under-delivered. 24% of eligible US patients took part in 2020, and European capacity is one place for every seven patients in need. (sources/crp-nejm-2024, rating: high)
- The outcome evidence is narrower than the class of recommendation. CR reduces cardiovascular mortality, MI and hospitalisation in ACS and CCS, but pooled randomised data show no all-cause mortality reduction; the survival signal is from registries. ESC 2026 grades it I A regardless. (sources/CRP-ESC-2026)
- Referral, not motivation, is the bottleneck. Automatic referral plus a clinician liaison reaches 73.5% enrolment against 29.0% with usual referral — OR 8.41 in 2,635 inpatients. (sources/CRP-ESC-2026)
- Delivery mode is genuinely contested. Telerehabilitation carries IIa B1 across five populations, yet an HF network meta-analysis found only centre-based CR reduced HF hospitalisation and mortality. (sources/CRP-ESC-2026)
- Frailty is not a reason to withhold it. Withholding CR because of frailty or comorbidity is III C, and PIpELINe showed benefit at a median age of 80. (sources/pipeline-mi-nejm-2025, rating: very high)
Definition
Cardiac rehabilitation is a medically supervised, multidisciplinary secondary-prevention programme for patients with cardiovascular disease. The US statutory definition — physician medical director, day-to-day physician or nonphysician practitioner supervision, and all core components delivered through individualised treatment plans updated every 30 days — is narrower than the clinical definition, and it is the one that determines reimbursement. (sources/cardiac-rehab-aha-2024, rating: very high)
The European definition is broader and now unqualified. ESC 2026 defines CR as a multimodal, multidisciplinary, patient-centred intervention delivered across Phases 0–III, and states that the term should no longer carry the qualifiers "exercise-based" or "comprehensive". It elevates functioning and health-related quality of life to independent primary outcomes alongside mortality and morbidity, and applies well beyond the seven Medicare diagnoses — see #Indications and Reimbursement. (sources/CRP-ESC-2026, rating: very high)
Key Concepts
- A continuous care pathway, not a course. Prehabilitation (Phase 0) runs into inpatient rehabilitation (Phase I), supervised post-acute rehabilitation (Phase II), and long-term maintenance (Phase III); the US model adds a fourth maintenance phase. The two numbering schemes are not interchangeable.
- Nine core components define a programme. Patient assessment, nutrition, weight and body composition, risk-factor management, psychosocial care, aerobic training, resistance training, physical-activity counselling, and programme quality. A service that omits the medical supervision or the core components is not CR.
- Intensity is prescribed two different ways. The US tradition uses %HRR and RPE; ESC 2026 prefers ventilatory thresholds and rejects MET-based classification. No head-to-head outcome comparison exists.
- The indication list is broad and the reimbursement list is narrow. Medicare funds seven diagnoses; ESC 2026 recommends CR across a dozen populations and makes withholding it on grounds of frailty or comorbidity a Class III recommendation.
- Access and referral, not patient motivation, determine uptake. Automatic referral is the single most effective lever, and programme capacity is the binding constraint.
- Delivery mode is unsettled. Centre-based, home-based and hybrid models are all endorsed, but the network meta-analyses disagree about whether home delivery preserves the outcome benefit.
Epidemiology and Access
- Only ~24% of eligible US patients participated in CR in 2020 — one of the largest quality gaps in cardiovascular medicine. Only 24% enrolled within 21 days of the qualifying event, only 27% completed the full 36-session course, and estimated programme capacity is sufficient for 37% of eligible patients. (sources/crp-nejm-2024, rating: high)
- Disparities by subgroup: women 18.9%; age >85 years 9.8%; non-Hispanic Black 13.6%; Hispanic 13.2%; dual Medicare–Medicaid 6.9%. Geography is as strong as any of these — 39% participation in the West North Central census division against 20% in the East South Central, West South Central, Middle Atlantic and Pacific divisions. (sources/crp-nejm-2024)
- Trends 1997→2020: CABG 31%→55%; post-MI with PCI 21%→33%; post-MI without revascularisation fell from 11% to 7%. (sources/crp-nejm-2024)
- European capacity is one place for every seven patients in need. CR is available in 91% of European countries but would require ~3 million additional places per year to meet demand; globally only 1 in 18 patients has access. Participation runs 9%–50% of eligible patients, referral and attendance 4.5%–71.1%, adherence 4%–62%, and roughly 40% of European programmes lack social-security funding. (sources/CRP-ESC-2026, rating: very high)
- Automatic referral plus clinician liaison is the single most effective enrolment intervention: 85.8% referral and 73.5% enrolment versus 32.2% and 29.0% with usual referral (OR 8.41), in 2,635 CAD inpatients. Automatic referral alone gives OR 3.27, liaison alone OR 3.35, and inviting the patient to an initial assessment OR 4.22 in men and 4.03 in women. (sources/CRP-ESC-2026)
- Timing matters more than almost anything else. Participation falls 1% for every 1-day delay in enrolment; ideal enrolment is within 1–2 weeks of the event, and enrolling within 15 days rather than after 30 days yields 67% greater improvement in exercise capacity. (sources/crp-nejm-2024)
- Correctable system levers. Automatic referral systems with patient navigators raise participation from 30% to 74%; moderate financial incentives double completion among Medicaid-covered patients; removing cost-sharing adds ~6 sessions, theoretically worth a 6–12% mortality reduction at 1–2% per session attended. (sources/crp-nejm-2024)
- Quality is measured at three levels — system referral rates, programme enrolment and completion, and patient fitness, risk factors and psychosocial outcomes. The Million Hearts target is 70% enrolment from a 20% baseline, and AACVPR patient-level measures are submitted with triennial certification. (sources/cardiac-rehab-aha-2024, rating: very high)
Indications and Reimbursement
Medicare-defined qualifying diagnoses:
- Acute MI within the past 12 months
- Coronary artery bypass grafting
- Coronary angioplasty or stenting
- Heart valve repair or replacement
- Heart or heart–lung transplantation
- Stable angina
- Stable chronic heart failure: LVEF ≤35% with NYHA II–IV symptoms despite ≥6 weeks of optimal therapy
The ESC 2026 list is much broader than the reimbursement list. (sources/CRP-ESC-2026, rating: very high)
| Population | Class / LOE |
|---|---|
| ACS and CCS | I A (CV mortality, MI); I B1 (hospitalisation, VO2peak, HRQoL) |
| Chronic HFrEF; HFpEF | I B1 |
| Advanced HF with LVAD or after transplantation | I B1 |
| Decompensated HF, once safe | IIa B1 |
| Aortic stenosis after SAVR or TAVI | I B1 |
| ACHD with reduced fitness | I B1 |
| After ICD or CRT implantation | I B1 |
| Atrial fibrillation, including after ablation | IIa B1 |
| PAH with right ventricular dysfunction | IIa B1 |
| Cancer, especially at high CTR-CVT risk | IIa B1 |
| Frailty | I B2 |
| Withholding CR because of frailty or comorbidity | III C |
Benefit also extends to MINOCA, and several entries rest on functional rather than clinical endpoints. A 2021 meta-analysis of 10 RCTs in valve disease found the impact on mortality, hospitalisation and HRQoL uncertain, yet aortic stenosis after SAVR or TAVI still carries Class I B1. (sources/CRP-ESC-2026)
Programme Structure and Phases
Two conventions are in use and they are not the same. ESC 2026 describes Phases 0–III, beginning with prehabilitation; the US model describes four phases I–IV, ending with indefinite maintenance. (sources/CRP-ESC-2026, rating: very high; sources/crp-jcm-2025, rating: medium)
| Phase | Setting and timing | Content | Evidence |
|---|---|---|---|
| Phase 0 — prehabilitation (ESC only) | Before a planned intervention such as elective CABG or TAVI | Exercise and optimisation while waiting | Multimodal prehabilitation improves short-term outcomes before elective transplantation; the evidence base is otherwise thin |
| Phase I — inpatient | During the index admission | Sitting up, upper- and lower-limb function tests, short walks, risk-factor education, psychosocial support | Exercise from day 3–7 post-PCI reduces remodelling and raises LVEF; early rehabilitation within 3 days shortens stay; Phase I lowers revascularisation −20% and readmission −19% at ~1 year, dose-dependently |
| Phase II — early post-discharge | Begins 1–4 weeks after discharge; 6–12 weeks in Europe, 6–36 visits in the US, minimum 24 sessions | Supervised exercise with risk-factor control | A 3-month supervised programme plus 9 months of community self-management lowered MACE and improved LVEF and 6MWD versus medical therapy alone (Xiao 2021, n=164) |
| Phase III — long-term outpatient | Reduced supervision | Consolidating the Phase II lifestyle change | Sparse and inconsistent: an 8-week Phase III programme had no effect on non-fatal MI or HF hospitalisation at 5.6 years (Brawner 2017, n=230), whereas a 3-year multifactorial educational programme did reduce cardiac events (GOSPEL 2008, n=3,241) |
| Phase IV — maintenance (US only) | Indefinite | Sustaining heart-healthy behaviour | Little literature; patients commonly revert after programme completion |
(Table: sources/crp-jcm-2025, rating: medium)
Illness perception drives Phase II adherence. Patients who understand their condition sustain motivation longer; BIPQ scores improve early in Phase II then may fall again as awareness of chronicity raises emotional concerns (Darsin Singh 2023, n=450). (sources/crp-jcm-2025)
Core Components
The 2024 AHA/AACVPR statement defines nine core components. Strength training was separated from aerobic training as its own component, and programme quality was added as a new one. (sources/cardiac-rehab-aha-2024, rating: very high)
| Component | Key content |
|---|---|
| Patient assessment | Comprehensive medical, functional, social and home-environment evaluation; ITP at entry; outcomes report at completion |
| Nutritional counselling | Validated food-frequency questionnaire; DASH, Mediterranean or plant-based pattern; SMART goals; explicit dietitian referral criteria |
| Weight and body composition | Body fat-to-lean ratio as the primary target; waist circumference the most feasible field measure; programmes have limited effect on weight overall, and HIIT is the strongest exercise lever for body composition |
| CVD and risk-factor management | SBP <130 and DBP <80 mmHg; LDL-C <70 mg/dL, <55 mg/dL at very high risk; HbA1c <7% for most; cessation support for every current or recent smoker |
| Psychosocial management | Validated screening for depression, stress, anxiety, loneliness and substance use; CBT and stress-management techniques; persisting depression at completion predicts higher post-CR mortality |
| Aerobic exercise training | 3–5 days/week, 20–60 min, moderate to vigorous — see the prescription table below |
| Strength training | 2–3 non-consecutive days/week, 40–60% 1-RM, 8–10 exercises, 10–15 reps — aimed at frailty and fall prevention |
| Physical-activity counselling | ≥150 min/week moderate or ≥75 min/week vigorous; step-count monitoring; minimising sedentary time |
| Programme quality | Annual assessment at system, programme and patient level; equity focus; 70% enrolment target |
Exercise Prescription
| Parameter | Aerobic training | Resistance training |
|---|---|---|
| Frequency | 3–5 days/week — 3 supervised plus home exercise on non-CR days, ≥5 total | 2–3 non-consecutive days/week |
| Intensity | Moderate 40–59% HRR, RPE 12–13; vigorous 60–89% HRR, RPE 14–17. Do not use resting HR + 20–30 bpm or age-predicted maximum — both are too inaccurate in an individual | 40–60% of 1-RM; RPE 11–13 |
| Time and volume | 20–60 min per session including warm-up and cool-down | 1–3 sets × 8–10 exercises × 10–15 reps, advancing to 3 sets |
| Progression | Lengthen by 1–5 min per session to the goal duration first, then raise intensity in 5–10% steps | Add ~5% load for upper-body and 10–20% for lower-body work once the top of the rep range is comfortable |
| Type | Treadmill, cycle, elliptical, rowing, stair climbing, arm or leg ergometry | Machines, free weights, elastic bands or body weight; multijoint movements first when time is short |
| Goals | ≥15% rise in peak VO2, ≥40% rise in peak MET, ≥10% rise in 6MWD | Lean mass, strength, reduced fall risk |
(Table: sources/cardiac-rehab-aha-2024, rating: very high)
- Safety ceiling. Set the target 10 bpm below the heart rate at which any of the following appears: angina or other symptoms of cardiovascular insufficiency; a plateau or fall in systolic pressure, SBP >240 mmHg or DBP >110 mmHg; ST depression >1 mm horizontal or downsloping; reversible ischaemia or moderate–severe wall-motion abnormality on imaging; increased ventricular ectopy; second- or third-degree AV block, AF, SVT or complex ventricular ectopy; or any other sign of exertional intolerance. (sources/cardiac-rehab-aha-2024)
- Breathing instruction for resistance work — exhale on contraction, inhale on relaxation — is the critical safety point when the session is delivered remotely. (sources/cardiac-rehab-aha-2024)
- Frailty and fall assessment at entry: Timed Up and Go (≥12 s = fall risk); 30-Second Chair Stand against age and sex norms; 4-Stage Balance Test; Berg Balance Scale (41–56 independent, 21–40 walking assistance, 0–20 wheelchair-bound). (sources/cardiac-rehab-aha-2024)
ESC 2026 rejects the percentage-of-maximum paradigm. It prefers ventilatory thresholds over %HRpeak, %HRR or %VO2peak, and discourages MET-based classification because MET 4–6 may be supramaximal for many cardiac patients; thresholds can be estimated from resting and peak heart rate when gas exchange is unavailable. Low-capacity or recently decompensated patients start at 40% VO2peak and progress to VT1 (50–60%) then VT2 (65–90%). Sessions are two-thirds endurance, one-third resistance, with a weekly energy target of 1000–2000 kcal in ACS and CCS and >1000 kcal in chronic HF. In chronic HF, IMT is added at 3–5 sessions/week up to daily, 20–30 min, from 30% to 60% of maximal inspiratory pressure. HIIT is superior or more time-efficient for VO2peak but capped at IIb B1 — protocol uncertainty and absent unsupervised safety data confine it to supervised, medically cleared patients. (sources/CRP-ESC-2026, rating: very high)
Delivery Models
- Four modes: in-person; virtual, with real-time audiovisual contact throughout the session; remote, where wearables and digital platforms relay data with no real-time interaction; and hybrid, the most likely route to closing the enrolment gap.
- Virtual and remote CR match in-person CR for efficacy and safety in low-to-moderate-risk patients, but any model lacking physician oversight and the full core components is not CR and is not an acceptable substitute. (sources/cardiac-rehab-aha-2024, rating: very high)
- ESC 2026 sets a floor of 24 sessions over 12 weeks, two per week, regardless of mode, and endorses cardiac telerehabilitation or hybrid delivery at IIa B1 in ACS/CCS, HF, ACHD, AF and cancer. Home-based CR without digital support is only IIb B1. (sources/CRP-ESC-2026, rating: very high)
- The mode evidence conflicts. A Cochrane meta-regression found consistent benefit irrespective of mode, and a telerehabilitation-versus-hybrid review found full telerehabilitation slightly superior for exercise capacity with 87% adherence and severe adverse events at 1 per 23,823 patient-hours. Against that, a CAD network meta-analysis found exercise effectiveness considerably reduced when home-delivered, and an HF network meta-analysis (139 RCTs, 18,670 patients) found that only centre-based CR significantly reduced HF hospitalisation and mortality, by ~60%. (sources/CRP-ESC-2026)
Special Populations
Elderly and frail patients. Traditional programmes were designed for younger post-surgical patients; older and frail patients participate less, withdraw earlier, and gain less from conventional intensive protocols. After age 70 aerobic capacity declines by >20% per decade, and the median age in home-based CR studies is ~68 years — well below the elderly post-MI population. (sources/pipeline-mi-nejm-2025, rating: very high)
| PIpELINe (NEJM 2025, n=512, median age 80, 2:1 allocation) | Result |
|---|---|
| Primary outcome — CV death or unplanned CV hospitalisation at 1 year | HR 0.57 (95% CI 0.36–0.89), P=0.01; NNT ≈12.5 |
| HF hospitalisation | HR 0.20 (95% CI 0.07–0.56) |
| CV death | HR 0.69 (NS) |
| Unplanned CV hospitalisation | HR 0.48 |
| Physical performance and QoL (SPPB, gait speed, grip strength, EQ-5D-5L) | Improved at 6 and 12 months |
| Safety and adherence | No serious adverse events; 71% compliance |
- The intervention was low-intensity and session-limited: 12-month multidomain care — risk-factor management, dietary counselling and exercise training — in patients ≥65 with SPPB 4–9 at one month after MI. Benefit was consistent across diabetes, CKD, LVEF ≤40%, prefrail and NSTEMI subgroups. (sources/pipeline-mi-nejm-2025)
- Exercise design for this group (Otago): balance plus upper- and lower-limb functional strength work, ≥20 min moderate walking ≥4×/week, 6 supervised sessions over 12 months with individualised home prescription between them, intensity set from a 1-km treadmill test. (sources/pipeline-mi-nejm-2025)
- Patient selection. SPPB 4–9 identifies the actionable zone — neither too fit for benefit to be measurable nor too compromised for it to be achievable. Goals extend beyond survival to functional independence and autonomy, and the HF hospitalisation reduction carries substantial socioeconomic value. (sources/pipeline-mi-nejm-2025)
- Beyond coronary disease, the same core components apply to cancer during or after cardiotoxic therapy (evolving into cardio-oncology rehabilitation, CORE), AF, ACHD, PAH with right ventricular dysfunction and CIED recipients. (sources/CRP-ESC-2026, rating: very high)
Rehabilitation in Heart Failure
Full detail: concepts/Cardiac-Rehabilitation-HF.
- Class and coverage. Patient-tailored exercise training within multidisciplinary exercise-based CR is I B1 for all stable HF patients, and outside CR I B2; CR is I B1 in LVAD recipients and IIa B1 in decompensated HF once safe. (sources/HF-ESC-2026, rating: very high)
- What it achieves. Exercise training improves exercise capacity and HRQoL and reduces HF hospitalisation; it does not reduce all-cause mortality. In HFrEF peak VO2 rises ~15–17% with modest, inconsistent LVEF change — LVEF is not a valid marker of benefit. (sources/crp-hf-jacc-2021, rating: high)
- HFpEF. Exercise capacity and QoL improve reliably; diastolic function, arterial stiffness and vascular function do not change materially. (sources/HF-ESC-2026)
- Composition. Endurance plus resistance plus inspiratory muscle training is the HF-specific template, rather than endurance alone. (sources/crp-hf-jacc-2021)
- Interval training is not established as superior. SMARTEX-HF found HIIT no better than moderate continuous training for LV remodelling or aerobic capacity; MCT is preferred in LVAD because of autonomic and circulatory hysteresis. (sources/crp-hf-jacc-2021)
- Supervision matters in HF more than elsewhere — this population contributes most of the evidence that centre-based delivery outperforms home-based. See #Contradictions / Open Questions.
Rationale and Evidence
Training works through central and peripheral adaptations at once: it lowers filling pressures, improves endothelial function, restores sympathovagal balance, blunts the ergoreflex, and reverses skeletal-muscle fibre-type and oxidative-capacity changes. That is why functional capacity improves even when LVEF does not. (sources/CRP-ESC-2026, rating: very high)
| Evidence | Population | Finding |
|---|---|---|
| Systematic review of randomised trials | Coronary heart disease | Little or no effect on all-cause mortality |
| Meta-analysis 2023 (n=23,172) | ACS and CCS | Reduced CV mortality, MI and all-cause hospitalisation; no reduction in all-cause mortality or revascularisation |
| HF-ACTION (n=2,331) | HFrEF, NYHA II–IV | Supervised training plus usual care: non-significant reductions in all-cause death and hospitalisation; prespecified adjustment showed reductions in CV death and HF hospitalisation |
| Systematic review (n=8,728) | HF | Improved functional capacity, QoL and HF hospitalisation; no mortality reduction |
| SWEDEHEART, Medicare post-PCI registries | Post-MI, post-PCI | 1–2% mortality reduction per session attended, dose-dependent |
(Sources: sources/crp-nejm-2024, rating: high; sources/CRP-ESC-2026, rating: very high)
The gap between the randomised and observational columns is the central interpretive problem here, and is the first contradiction below. Set against it, CR reliably improves functional capacity, psychological health, adherence, risk-factor control and return to work, and appears cost-effective. (sources/CRP-ESC-2026; sources/crp-nejm-2024)
Contradictions / Open Questions
- The randomised and observational mortality evidence diverge, and the guideline grades around the gap. Systematic review of CR trials shows little or no effect on all-cause mortality; registries show a 1–2% reduction per session attended. Better usual care, older trial quality, or healthy-participant bias could each explain it. ESC 2026 nonetheless assigns I A for cardiovascular mortality and MI in ACS/CCS and blames modern background therapy for the discrepancy — a class implying more certainty than the randomised evidence carries. (sources/crp-nejm-2024, rating: high; sources/CRP-ESC-2026, rating: very high)
- Centre-based versus home-based delivery is unresolved and the analyses point opposite ways. Telerehabilitation carries IIa B1 across five populations, yet the HF network meta-analysis found only centre-based CR reduced HF hospitalisation and mortality, and the CAD network meta-analysis found exercise effectiveness "considerably reduced" when home-delivered. The guideline notes the comparisons are difficult without reconciling them.
- The exercise-intensity paradigm is changing. The US tradition prescribes by %HRR and RPE; ESC 2026 prefers ventilatory thresholds and discourages MET-based classification. Both remain in the literature, and no head-to-head outcome comparison exists.
- The phase numbering is inconsistent between the two frameworks. ESC 2026 runs Phase 0–III from prehabilitation; the US model runs I–IV to indefinite maintenance. A "Phase IV" programme in one scheme is a "Phase III" activity in the other, which matters for comparing programme data across countries.
- A Class III recommendation runs against referral practice. Frailty and comorbidity are explicit reasons not to withhold CR, yet the guideline also records both as prevalent in referrals and both discouraging referral — an implementation gap dressed as an evidence gap.
- Digital delivery is weakest exactly where the need is greatest. Short-term equivalence is established, but long-term outcome data are thin, phone- and internet-based psychosocial interventions are not clearly equivalent to face-to-face care, and the RESILIENT RCT found mobile-health CR did not improve 6MWD, health status or daily activities in older adults with ischaemic heart disease. (sources/crp-jcm-2025, rating: medium)
- Body-composition targets are unvalidated across populations. Waist circumference and bioelectrical-impedance cut-offs have not been validated across racial and ethnic subgroups, and DXA thresholds for adiposity and sarcopenia may differ by ancestry — while standard CR programmes have only limited effect on weight and composition anyway. (sources/cardiac-rehab-aha-2024, rating: very high)
- HIIT in high-risk patients is unproven. HIIT is safe and effective in low-to-moderate-risk patients but the evidence in recent ACS, advanced HF, complex arrhythmia and severe frailty is limited. PIpELINe provides the counter-example that low-intensity, session-limited work achieves meaningful outcomes in patients at median age 80 with SPPB 4–9. (sources/pipeline-mi-nejm-2025, rating: very high)
- The frailty threshold that predicts benefit is undefined. PIpELINe paradoxically showed a stronger effect in prefrail (HR 0.48) than frail patients (HR 0.87), and no benefit in the PAD subgroup (HR 1.06). The optimal SPPB or frailty-phenotype cut-off, and the point at which comorbidity makes rehabilitation futile, remain unknown. (sources/pipeline-mi-nejm-2025)
- HFpEF is recommended in Europe and unfunded in the United States. ESC 2026 gives CR in HFpEF I B1 on the strength of exercise-capacity and QoL data, while CMS provides no coverage for HFpEF at all — the widest gap on this page between guideline class and payer policy. (sources/HF-ESC-2026, rating: very high; sources/crp-hf-jacc-2021, rating: high)
Connections
- Secondary prevention after an event: concepts/ACS-Management · entities/Acute-Coronary-Syndrome — referral before discharge is Class I/A, and home-based CR is equivalent for eligible low-risk patients
- Heart failure: entities/Heart-Failure · concepts/HFpEF-Management · concepts/Decompensated-HF-Management — where the outcome evidence and the delivery-mode controversy are strongest
- Exercise physiology and testing: concepts/Cardiopulmonary-Exercise-Testing · concepts/VO2max · concepts/HCM-Exercise — the FITT framework and threshold-based prescription applied outside secondary prevention
- Risk factors and lifestyle: concepts/Dyslipidemia · concepts/Heart-Healthy-Dietary-Patterns · concepts/Obesity-Paradox — CR targets are the secondary-prevention guideline targets
- Frailty and the older patient: entities/Frailty-in-Cardiovascular-Disease — SPPB, the Otago programme and PIpELINe
- Rehabilitation beyond coronary disease: concepts/Autonomic-Dysfunction-in-Cancer — the CORE model for patients on cardiotoxic therapy
Sources
US framework
European framework
Access, delivery and epidemiology
Special populations
Heart failure detail page