Interdisciplinary Approaches to Cardiac Rehabilitation: Enhancing Patient Safety, Clinical Support, and Diagnostic Care
Abstract
Background: Cardiovascular disease is a leading global cause of morbidity and mortality. Cardiac rehabilitation (CR) is an established, evidence-based cornerstone of secondary prevention, designed to improve outcomes after cardiac events or procedures. However, despite proven benefits, enrollment and completion rates remain suboptimal.
Aim: This article reviews the comprehensive scope of interdisciplinary cardiac rehabilitation, detailing its physiological basis, clinical indications, and implementation to enhance patient safety, clinical support, and diagnostic care.
Methods: The review synthesizes current guidelines and research to describe the structure of CR. It outlines the anatomy and physiology underpinning exercise benefits, defines core program components, and details the phased approach (inpatient, outpatient, maintenance). The roles of diverse interprofessional team members and necessary equipment are examined.
Results: CR is a multifaceted intervention encompassing supervised exercise, risk factor modification, education, and psychosocial support. It significantly improves functional capacity, quality of life, and reduces hospital readmissions and mortality. The interprofessional model—involving cardiologists, nurses, physiotherapists, dietitians, and others—is crucial for its success. Safety is high, with major complications being extremely rare in supervised settings. Key challenges include persistent barriers to patient referral, access, and adherence.
Conclusion: Interdisciplinary cardiac rehabilitation is a highly effective and safe intervention for improving cardiovascular health. Optimizing patient outcomes requires a collaborative team approach, individualized care plans, and strategies to overcome systemic and personal barriers to participation.
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References
Tarride JE, Lim M, DesMeules M, Luo W, Burke N, O'Reilly D, Bowen J, Goeree R. A review of the cost of cardiovascular disease. The Canadian journal of cardiology. 2009 Jun:25(6):e195-202
Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ, American Heart Association Advocacy Coordinating Committee, Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011 Mar 1:123(8):933-44. doi: 10.1161/CIR.0b013e31820a55f5.
Servey JT, Stephens M. Cardiac Rehabilitation: Improving Function and Reducing Risk. American family physician. 2016 Jul 1:94(1):37-43
Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ (Clinical research ed.). 2015 Sep 29:351():h5000. doi: 10.1136/bmj.h5000.
Braverman DL. Cardiac rehabilitation: a contemporary review. American journal of physical medicine & rehabilitation. 2011 Jul:90(7):599-611. doi: 10.1097/PHM.0b013e31821f71a6.
Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. The Cochrane database of systematic reviews. 2016 Jan 5:2016(1):CD001800. doi: 10.1002/14651858.CD001800.pub3.
Park LG, Schopfer DW, Zhang N, Shen H, Whooley MA. Participation in Cardiac Rehabilitation Among Patients With Heart Failure. Journal of cardiac failure. 2017 May:23(5):427-431. doi: 10.1016/j.cardfail.2017.02.003.
Castellanos LR, Viramontes O, Bains NK, Zepeda IA. Disparities in Cardiac Rehabilitation Among Individuals from Racial and Ethnic Groups and Rural Communities-A Systematic Review. Journal of racial and ethnic health disparities. 2019 Feb:6(1):1-11. doi: 10.1007/s40615-018-0478-x.
Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, Franklin B, Sanderson B, Southard D, American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology, American Heart Association Council on Cardiovascular Nursing, American Heart Association Council on Epidemiology and Prevention, American Heart Association Council on Nutrition, Physical Activity, and Metabolism, American Association of Cardiovascular and Pulmonary Rehabilitation. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007 May 22:115(20):2675-82
Lavie CJ, Arena R, Swift DL, Johannsen NM, Sui X, Lee DC, Earnest CP, Church TS, O'Keefe JH, Milani RV, Blair SN. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circulation research. 2015 Jul 3:117(2):207-19. doi: 10.1161/CIRCRESAHA.117.305205.
Perry AS, Dooley EE, Master H, Spartano NL, Brittain EL, Pettee Gabriel K. Physical Activity Over the Lifecourse and Cardiovascular Disease. Circulation research. 2023 Jun 9:132(12):1725-1740. doi: 10.1161/CIRCRESAHA.123.322121.
Santos-Parker JR, LaRocca TJ, Seals DR. Aerobic exercise and other healthy lifestyle factors that influence vascular aging. Advances in physiology education. 2014 Dec:38(4):296-307. doi: 10.1152/advan.00088.2014.
Balady GJ, Ades PA, Bittner VA, Franklin BA, Gordon NF, Thomas RJ, Tomaselli GF, Yancy CW, American Heart Association Science Advisory and Coordinating Committee. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011 Dec 20:124(25):2951-60. doi: 10.1161/CIR.0b013e31823b21e2.
Mampuya WM. Cardiac rehabilitation past, present and future: an overview. Cardiovascular diagnosis and therapy. 2012 Mar:2(1):38-49. doi: 10.3978/j.issn.2223-3652.2012.01.02.
Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, Singh S. Exercise-based rehabilitation for heart failure. The Cochrane database of systematic reviews. 2014 Apr 27:2014(4):CD003331. doi: 10.1002/14651858.CD003331.pub4.
Naughton J, Lategola MT, Shanbour K. A physical rehabilitation program for cardiac patients: a progress report. The American journal of the medical sciences. 1966 Nov:252(5):545-53
McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends in cardiovascular medicine. 2017 Aug:27(6):420-425. doi: 10.1016/j.tcm.2017.02.005.
Achttien RJ, Staal JB, van der Voort S, Kemps HM, Koers H, Jongert MW, Hendriks EJ, Practice Recommendations Development Group. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2015 Jan:23(1):6-17. doi: 10.1007/s12471-014-0612-2.
Van Camp SP, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA. 1986 Sep 5:256(9):1160-3
Pavy B, Iliou MC, Meurin P, Tabet JY, Corone S, Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology. Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation. Archives of internal medicine. 2006 Nov 27:166(21):2329-34
Rakhshan M, Ansari L, Molazem Z, Zare N. Complications of Heart Rhythm Management Devices After Cardiac Rehabilitation Program. Clinical nurse specialist CNS. 2017 May/Jun:31(3):E1-E6. doi: 10.1097/NUR.0000000000000293.
Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. Journal of the American College of Cardiology. 2016 Jan 5:67(1):1-12. doi: 10.1016/j.jacc.2015.10.044.
Milani RV, Lavie CJ, Cassidy MM. Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. American heart journal. 1996 Oct:132(4):726-32
Veen EV, Bovendeert JFM, Backx FJG, Huisstede BMA. E-coaching: New future for cardiac rehabilitation? A systematic review. Patient education and counseling. 2017 Dec:100(12):2218-2230. doi: 10.1016/j.pec.2017.04.017.
Amedro P, Gavotto A, Bredy C, Guillaumont S. [Cardiac rehabilitation for children and adults with congenital heart disease]. Presse medicale (Paris, France : 1983). 2017 May:46(5):530-537. doi: 10.1016/j.lpm.2016.12.001.
Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS, American Heart Association, Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention), Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), American association of Cardiovascular and Pulmonary Rehabilitation. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005 Jan 25:111(3):369-76
Bäck M, Öberg B, Krevers B. Important aspects in relation to patients' attendance at exercise-based cardiac rehabilitation - facilitators, barriers and physiotherapist's role: a qualitative study. BMC cardiovascular disorders. 2017 Mar 14:17(1):77. doi: 10.1186/s12872-017-0512-7.
Bordoni B, Mapelli L, Toccafondi A, Di Salvo F, Cannadoro G, Gonella M, Escher AR, Morici N. Post-Myocardial Infarction Rehabilitation: The Absence in the Rehabilitation Process of the Diaphragm Muscle. International journal of general medicine. 2024:17():3201-3210. doi: 10.2147/IJGM.S470878.
Bordoni B, Escher AR. The Importance of Diaphragmatic Function in Neuromuscular Expression in Patients With Chronic Heart Failure. Cureus. 2023 Feb:15(2):e34629. doi: 10.7759/cureus.34629.
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Copyright (c) 2024 Ibrahim Abdulaziz Alhariqi, Ali Waleed Khalafallah, Yazeed Awad Alanazi, Rakan Omar Bin Saud Alrajeh, Mohammed Nasser Mohammed Al Ajmi, Rayed Obeed Harab Al-Mutairi, Aliyan Manawer Aliyan Al-Mutairi, Mohd Rashed Modhi Algabaan, Abdulaziz Musaad Alabdan, Ahmed Mohammed Bindurayhim
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