Cardiac rehabilitation: A class 1 recommendation

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Figure 1
Rates of referral to cardiac rehabilitation compared with other quality measures for acute myocardial infarction (MI) established by the Centers for Medicare and Medicaid Services (P < .001 for cardiac rehabilitation referral compared with other interventions).

TABLE 1

Phases of cardiac rehabilitation

Phase 1	Inpatient	Discussion with primary provider Early mobilization, mild activity Referral
Phase 2	Outpatient	Comprehensive secondary prevention model Individualized treatment plan Exercise prescription Education classes Risk modification: smoking, hypertension, diabetes, cholesterol, obesity, nutrition Psychosocial counseling
Phase 3	Maintenance	Cardiac monitoring no longer needed Independent continuation of risk-factor modification and exercise, with periodic physician evaluation

TABLE 2

Indications for cardiac rehabilitation approved by the Centers for Medicare and Medicaid Services

Coronary artery bypass grafting

Myocardial infarction in the past 12 months

Percutaneous coronary angioplasty or intervention

Chronic stable angina

Heart valve repair or replacement

Heart failure (must fit all 3 criteria)

New York Heart Association class II–IV

Left ventricular ejection fraction ≤ 35%

Stable on medical therapy without hospitalization or planned procedure in past 6 weeks

Heart or heart and lung transplant

Peripheral artery disease

TABLE 3

When to start phase 2 cardiac rehabilitation

Uncomplicated myocardial infarction, percutaneous coronary intervention (patients with normal or mildly reduced left ventricular ejection fraction)	Within 14 days of event
Minimally invasive open-heart surgery	Within 4 weeks
Heart surgery involving sternotomy	After 6 weeks