Public health

Cardiac rehabilitation has to move with the times

Cardiac rehabilitation has largely failed to keep pace with changes in medical and surgical management of myocardial infarction over the last 75 years and the emergence of digital health in the 21st Century.

Even the term ‘rehabilitation’ should be up for discussion, according to a Review article published in Frontiers in Cardiovascular Medicine.

The Review, led by Professor Julie Redfern from the University of Sydney, said the historical approach to MI prior to 1950 was absolute bed rest.

That approach gradually relaxed during the 50s and 60s as emerging research started to support regular and supervised exercise programs to overcome the sequelae of immobility and associated deconditioning.

“By the 1970s, a model of structured “rehabilitation” for patients with CHD was progressively introduced around the world,” the Review said.

“The benefits of supervised exercise programs provided a new approach to post-discharge care and eventually evolved into what we know today as outpatient or traditional “cardiac rehabilitation.”

The Review said international guidelines universally recommended cardiac rehabilitation through the next 20-30 years although “rates of referral, access to programs and adherence to recommendations remained problematic.”

According to the authors, cardiac rehabilitation has proved to be inflexible and has not leveraged the opportunities for digital technologies to support interaction with patients, drive behaviour change and overcome inequities in access to programs and education.

“For example, individuals who do not speak the language of the country in which they live, those who live in rural and remote geographical areas, those with socioeconomic disadvantage and women remain under-represented in cardiac rehabilitation.”

COVID-19 lockdowns had also pulled the handbrake on the delivery of cardiac rehabilitation and there was an opportunity to modernise.

While the use of digital technology including mobile applications, tracking sensors and text messaging was still evolving and being trialled, the strategies certainly offered promise.

Amongst its recommendations, the Review said a focus on lifelong preventive strategies rather the time-limited programs of traditional cardiac rehab would also improve patient care and outcomes.

“Since cardiac rehabilitation programs emerged, there have been enormous changes to both the medical and surgical care of patients with CVD coupled with transformation of societies and technology,” the Review said.

“Very few patients now need a period of “rehabilitation,” but rather life-long multifaceted prevention is needed to reduce the CVD burden.”

Other Australian co-authors included Professors Robyn Gallagher and Adrienne O’Neil (Deakin Uni), Professor Garry Jennings (Heart Foundation), Professors Adrian Bauman and David Brieger (Sydney Uni), and Associate Professor Tom Briffa (University of Western Australia).

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