The AHA Guidelines and Scientific Statements Handbook

Cardiac Rehabilitation and Secondary

Prevention Programs

Mark A. Williams and Gary J. Balady

4

Introduction
Defi nition of cardiac rehabilitation/secondary
prevention
Appropriate patients for cardiac rehabilitation/
secondary prevention
CR/SP programming structure
Underutilization of cardiac rehabilitation/secondary
prevention services
Core components of cardiac rehabilitation/secondary
prevention programs
Exercise training intervention
Safety considerations
Effect on exercise capacity
Return to work
Effect on CVD prognosis
Cardioprotective mechanisms
Psychosocial interventions
Performance measures
Summary of the measures
Comparison with other national guidelines
Future research
Appendix A. Cardiac Rehabilitation/Secondary
Prevention Performance Measurement Set A
Performance Measure A-1: Cardiac rehabilitation
patient referral from an inpatient setting
Performance Measure A-2: Cardiac rehabilitation
patient referral from an outpatient setting
Appendix B. Cardiac Rehabilitation/Secondary
Prevention Performance Measurement Set B
Performance Measure B-1: Structure-based
measurement set
Performance Measure B-2: Assessment of risk for
adverse cardiovascular events
Performance Measure B-3: Individualized assessment
and evaluation of modifi able cardiovascular risk

factors, development of individualized

interventions, and communication with other

healthcare providers

Performance Measure B-3a: Individualized assessment

of tobacco use

Performance Measure B-3b: Individualized assessment

of blood pressure (BP) control

Performance Measure B-3c: Individualized assessment

of optimal lipid control

Performance Measure B-3d: Individualized assessment

of physical activity habits

Performance Measure B-3e: Individualized assessment

of weight management

Performance Measure B-3f: Individualized assessment

of the diagnosis of diabetes mellitus (DM) or

impaired fasting glucose (IFG)

Performance Measure B-3g: Individualized assessment

of the presence or absence of depression

Performance Measure B-3h: Individualized assessment

of exercise capacity

Performance Measure B-3i: Individualized adherence

to preventive medications

Performance Measure B-3j: Communication with

healthcare providers

Performance Measure B-4: Monitor response to

therapy and document program effectiveness

Introduction

Cardiac Rehabilitation/Secondary Prevention (CR/

SP) programming is an essential part of the contem-

porary care of patients with cardiovascular disease

(CVD) [1–12] and is recommended as useful and

effective (Class I) by the American Heart Associa-

tion (AHA) and the American College of Cardiology

(ACC) in the treatment of patients with coronary

artery disease (CAD) [13–15] and chronic heart

failure [16]. Consensus statements from the AHA

[1], the American Association of Cardiovascular and

Pulmonary Rehabilitation (AACVPR) [17], and the

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2