FROM CARDIAC REHABILITATION TO SECONDARY PREVENTION

Cardiovascular disease (CVD) is the leading cause of death in most countries world-wide. Nevertheless, life expectancy has increased by 8 years in most countries of the Western world during the last 20 years; 6 years of these life years’ gain is due to a decrease of CVD. 48% of CVD mortality reduction since 1980 has come from reduction in smoking, 30% of reduction comes from secondary prevention and other primary prevention. Only 4 months of these 6 life years’ gains are due to interventional treatment. Challenges for CVD disease prevention and rehabilitation programs are a growing number of elderly, more fragile patients with co-morbidities, a growing number of younger patients with obesity, diabetes, and early stages of CVD and the need for CVD risk assessment clinics to detect subclinical disease before a first clinical event. Benefits of cardiac rehabilitation and secondary prevention programs include the reduction in overall and cardiovascular mortality by 25 – 50%, slowing of the atherosclerotic process, and decrease of rates of subsequent coronary events and re-hospitalizations. These benefits are thought to be mediated by several factors, including the physiological benefits of exercise training, psychological benefits of group support and counseling, improved adherence to preventive therapies, and improved control of cardiovascular risk factors. The scientific evidence behind the practice comes mainly from ambulatory cardiac rehabilitation programs lasting at least 8 – 12 weeks including preferably 36 sessions. Long-term adherence can be improved by long-term multifactorial continued education programs for lifestyle changes and pharmacological treatment. A multi-disciplinary team approach is essential for success.