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Cardiopulmonary Rehabilitation (CR) is a branch of rehabilitation medicine dealing with optimizing physical function in patients with cardiac and pulmonary diseases. CR services are generally provided in an outpatient setting as comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. While the "glue" of cardiac rehabilitation is exercise, programs are evolving to become comprehensive prevention centers where all aspects of preventive cardiology care are delivered. This includes nutritional therapies, weight loss programs, management of lipid abnormalities with diet and medication, blood pressure control, diabetes management and stress management.

Patients typically enter cardiac rehabilitation in the weeks following an acute coronary event such as an myocardial infarction (heart attack), coronary bypass surgery, coronary stent placement or replacement of a heart valve. Participation typically begins with an intake evaluation that includes measurement of cardiac risk factors such as lipid measures, blood pressure, body weight and smoking status. An exercise stress test is usually performed both to determine that exercise is safe and to allow for the development of an exercise prescription. Short and long-term risk factor goals are established and patients are closely monitored by a "case-manager" who may be a cardiac trained nurse, a physical therapist or an exercise physiologist.

Participation in cardiac rehabilitation is associated with a 25% decrease in overall mortality over 3 years so when one is asked "is it safe for patients with cardiac disease to exercise ?" an appropriate response would be "it is not safe for cardiac patients NOT to exercise" (after appropriate medical evaluation).

CR services are significantly underused in the United States with only 19-29% of patients with eligible cardiac diagnoses participating. Underuse is related to many factors including a geographical lack of an available program and low referral rates by physicians who often focus more attention on better reimbursed cardiac interventional procedures than on long-term lifestyle treatments. With a contemporary focus on the cost-effectiveness of medical interventions, CR programs are well positioned to assume a more prominent role in the long-term care of patients with coronary heart disease. CR exercise and prevention programs are supported by Scientific Statements from the American Heart Association and the American College of Cardiology.

References: 1. Ades PA Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease. New England Journal of Medicine. 2001 Sep 20;345(12):892-902. 2. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Circulation. 2007 Oct 9;116(15):1653-62. 3. Receipt of cardiac rehabilitation services among heart attack survivors--19 states and the District of Columbia. Ayala C et al. Morbid Mortality Weekly. 2003; 52:1072-1075



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