Cardiac rehabilitation and secondary prevention after acute MI

Cardiac rehabilitation programs for patients following an acute MI originally consisted of early ambulation and moderate-intensity physical activity in the hospital and following discharge in order to counter the debilitating effects of bed rest. They subsequently have evolved into comprehensive, multifaceted, physician-supervised programs targeted not only at improving the patient's functional capacity but also for preventing recurrent (secondary) coronary and other cardiovascular events. These cardiac rehabilitation/secondary prevention programs (CRSPP) currently include, in addition to supervised exercise training, intense risk factor modification, patient and family education about coronary heart disease, psychosocial counseling and support, and, if necessary, vocational and occupational counseling. CRSPP in addition to improving the patient's functional capacity, and hence quality of life, have been shown by meta-analyses of randomized trials to reduce fatal and nonfatal cardiovascular recurrent events as well as all-cause mortality. The purpose of this chapter is to review the evolution of such programs, the research-based evidence of their benefits, and their recommended components and personnel.