Cardiac rehabilitation - moving forward with new models of care

Background: Early prevention programmes, termed cardiac rehabilitation (CR), have been the traditional model for delivery of secondary prevention for patients with coronary heart disease (CHD). They consistently reduce mortality, coronary disease risk and improve quality of life. These programmes have involved attendance at rehabilitation facilities, mostly in hospitals, to participate in 6-8 week programmes of group-based health education, supervised exercise and psychosocial support. Strikingly, these programmes are poorly (10-30% of those eligible) attended, variously resourced and largely rejected by those in greatest need. With advancements in knowledge, medical technology and pharmacotherapy the number of people surviving acute coronary events is increasing, as is the frequency of repeat events, and as a matter of social justice the demand for effective secondary prevention is intensifying. Therefore, improving access and equity to an effective secondary prevention programme for patients with established disease is a pressing and urgent priority. Objective: The aim of this review is to summarize information currently available surrounding models of delivery of secondary prevention for people with CHD. Conclusions: Recent evidence suggests that more contemporary models of secondary prevention are safe and appear to benefit patients of all ages. These programmes complement traditional CR and provide more flexible and individualized interventions that frequently include ongoing support over the telephone, the internet (in limited cases) and the provision of taped or written supplementary materials. Provision of flexible models for delivery of secondary prevention in addition to standard medical care is likely to help close the well-documented evidence-practice gap by improving equity and access to services.