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The benefits of attending a Cardiac Rehabilitation (CR) programme

Comment by Maria Simonenko, Exercise Basic & Translational Research Section

Secondary Prevention
Risk Factors and Prevention

The recently published new results by Kornelia Kotseva et al. are about the proportions of patients referred to and attending cardiac rehabilitation programmes in Europe and comparing lifestyle and risk factor targets achieved according to participation in a cardiac rehabilitation (CR) programme. The EUROASPIRE IV cross-sectional survey was undertaken in 78 centres from 24 European countries. For that matter, they analysed a total of 7998 patients: 51% were advised to participate in a CR programme and 81% of them attended at least half of the sessions.

According to their results, the proportions of patients achieving lifestyle targets were higher in the cardiac rehabilitation programme group as compared to the non-CR programme group: stopping smoking (57% vs. 47%, p<0.0001), recommended physical activity levels (47% vs. 38%, p<0.0001) and body mass index <30 kg/m2 (65% vs. 61%, p=0.0007). Moreover, previous researches over the last 14 years have shown adverse lifestyle trends, a substantial increase in obesity, central obesity and diabetes, and high prevalence of persistent smoking, especially in younger patients and especially women. Back to 2002, T. Kavanagh et al. have published results about the prediction of long-term prognosis in men referred for CR. According to their results, exercise capacity, as determined by direct measurement of VO2peak, exerts a huge impact on the prognosis in men after myocardial infarction, coronary artery bypass graft (CABG) or ischemic heart disease (IHD) and can play a valuable role in risk stratification and counseling [1].
However, in the current study patients have been interviewed via HeartQoL questionnaire which is difficult to compare with other articles due to the use of world-known SF-36 or others validated questionnaires. Despite the known benefits of CR/secondary prevention and despite the widespread endorsement of its use, CR is vastly underutilized, with less than 30% of eligible patients’ participation in a CR program after a CVD event [2]. In fact, the prevalence of frailty and its clinical and prognostic relevance has not yet been well characterized in the environment of CR, although many studies have reported the measurement of frailty in patients with coronary syndromes in intensive care units or in cardiology wards, and others have underscored the close link between frailty and CHF [3].

The negative point is that there is no particular information about the transthoracic echocardiogram (TTE) results; especially did patients in this study have chronic heart failure? I totally agree with authors that CR continues to be widely underused with completely inadequate referral and low participation rates. In addition, it will be interesting to see more results about how gender has an impact on referring to CR.

In conclusion, K. Kotseva et al. suggested that patients attending a CR programme were more likely to achieve lifestyle targets, had lower depression and anxiety, and better medication adherence. I believe that this research needs to be continued and maybe not only European countries should be involved in the future to obtain results based on the world population. 

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Maria Simonenko commented on this article:

Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey
Kornelia Kotseva et al; European Journal of Preventive Cardiology (June 2018), doi: 10.1177/2047487318781359

Additional references:

  1. Terence Kavanagh, Donald J. Mertens, Larry F. Hamm, Joseph Beyene, Johanna Kennedy, Paul Corey, Roy J. Shephard – Prediction of Long-Term Prognosis in 12 169 Men Referred for Cardiac Rehabilitation, Circulation, 2002; 106:666-671. DOI: 10.1161/01.CIR.0000024413.15949.ED
  2. Randal J. Thomas, Marjorie King, Karen Lui, Neil Oldridge, Ileana L. Pina, John Spertus – AACVPR/ACC/AHA 2007 Perfomance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services, Journal of the American College of Cardiology, Vol. 50, №14, 2007. DOI: 10.1016/j.jacc.2007.04.033
  3. Carlo Vigorito, Ana Abreu, Marco Ambrosetti, Romualdo Belardinelli, Ugo Corra, Margaret Cupples, Constantinos H. Davos, Stefan Hoefer, Maria-Christine Iliou, Jean-Paul Schmid, Heinz Voeller and Patrick Doherty - Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section, European Journal of Preventive Cardiology, 2017, Vol. 24(6): 577-590. DOI: 10.1177/2047487316682