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With the emergence of new and effective secondary prevention pharmacological agents, is there still a place for cardiac rehabilitation?
Professor Paul Dendale (Jessa Hospital, Hasselt, Belgium), President of the European Association of Preventive Cardiology (EAPC) and speaker at yesterday’s session ‘Is cardiac rehabilitation still a must in the 21st century?’, thinks there most definitely is. “Meta-analyses1 have shown that rehabilitation can produce similar reductions in morbidity and mortality as achieved with classical drug treatment, such as aspirin and statins. Rehabilitation programmes also teach patients how to adopt a new way of life, which is important given that about 80% of all cardiovascular disease is related to unhealthy lifestyles. So a combination of cardiac rehabilitation and pharmacotherapy is the best way to reduce the risk of recurrent events.” Despite the evidence in favour of cardiac rehabilitation, it remains a much-neglected approach.
“Only 20–50% of patients eligible for cardiac rehabilitation programmes are referred for them.”
“If we saw such a low level of prescribing for secondary prevention drugs, there would be an outcry,” says Prof. Dendale. “One of the problems is that the evidence relies on meta-analyses rather than large randomised trials. Another issue is that the level of reimbursement varies between countries, with some offering no reimbursement at all. Policy changes are needed if patient access to cardiac rehabilitation programmes is to be increased.”
In addition, the long-term benefits of cardiac rehabilitation may be reduced by a lack of adherence. “In the initial stages after an event, patient adherence to classical programme recommendations is good, but in time, many revert to their original, unhealthy lifestyles. This suggests that the standard programme approach needs to be improved.”
Prof. Dendale’s group conducted a study involving a classical 3-month programme with or without an additional 6-month internet-based, patient-tailored telerehabilitation programme.2 “Compared with the classical programme, the telerehabilitation programme led to larger improvements in fitness and in health-related quality of life. These types of programmes may also have greater cost-effectiveness.” He concludes, “Mobile health may be one way of making cardiac rehabilitation programmes both more effective and more widely available.”
Cardiac rehabilitation: is mobile health the way to go?Today, 08:30 – 10:00; Digital Health Stage 1 – Digital Health Area
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