Description of Treatment/Procedure

For at least the past two decades, risk factor modification programs for cardiac patients, commonly referred to as cardiac rehabilitation, have evolved into a comprehensive management strategy. Originally focusing on exercise training, these programs have evolved to emphasize overall risk factor and behavioral modification. There are four phases of cardiac rehabilitation. Phase I is the inpatient days. Phase II is the outpatient days immediately after hospitalization which usually lasts about 2-12 weeks. Phase III is the late recovery period with a minimum duration of 6 months beyond phase II. Phase IV is the maintenance program that patients should continue indefinitely.

Committee Summary

With regard to cardiac rehabilitation, the ICSI Technology Assessment Committee finds that:

1. Outpatient cardiac rehabilitation (CR) programs (Phase II, III, and IV) are safe for selected patients in stable condition with a diagnosis of atherosclerosis, acute myocardial infarction, percutaneous transluminal coronary angioplasty, coronary bypass surgery, or cardiac valve surgery including programs with an aerobic and/or strength training component.
   
2. CR programs with various components have been shown to be efficacious (Conclusion Grade I), however no gold standard CR program has been established. No studies have analyzed exercise-only versus comprehensive CR programs and it is unclear whether exercise only or comprehensive CR is more beneficial. Comprehensive CR programs including multifactorial coronary artery risk factor assessment and reduction have shown reductions in the number of cardiac events and hospitalizations as well as improvements in individual risk factors such as lipids, weight, and exercise capacity up to four years after beginning CR. One meta-analysis of 32 randomized controlled trials has shown a significant reduction in cardiac mortality for both exercise-only and comprehensive CR programs.
   
3. No studies have demonstrated the benefit of supervised versus unsupervised exercise in a CR program.
   
4. The Committee did not evaluate Phase I CR, as it is seen as part of the hospital care for these patients.