Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Cardiovascular Institute of North Colorado, Banner Health, 1800 15th St Suite 310, Greeley, CO, 80631, USA.
Curr Cardiol Rep. 2021 Nov 6;23(12):184. doi: 10.1007/s11886-021-01616-x.
Cardiac rehabilitation (CR) referral is a Class I post-myocardial infarction (MI) recommendation from the American Heart Association and the American College of Cardiology, yet referral rates remain strikingly low, with cardiologists some of the worst under-referring offenders. This paper seeks to review the evolution of CR and its well-established benefits, as well as reasons behind the poor referral and utilization.
CR is a secondary prevention program for cardiovascular disease (CVD) that was first initiated in the 1970s as a hospital-based exercise program after an acute MI, but then evolved into a comprehensive multi-disciplinary program for patients with a wider range of cardiovascular diseases. CR mortality and morbidity benefits have endured over decades, even as interventional and pharmacological cardiovascular therapeutics have improved and as patients have become relatively more stable. Despite being an evidence-based clinical standard, referral and participation in CR are disconcertingly low. In efforts to combat poor referral rates, and improve care in the contemporary care environment, the approach to CR is evolving. Innovations include broadening CR beyond the hospital setting into remote- and hybrid-based formats, while still incorporating exercise training, risk factor reduction, and education, as well as behavioral and psychosocial support. Nonetheless, there still remain many challenges to overcome in order to increase participation of all ages, financials, races, and sexes. With new performance measures as well as an increasing number of NIH-funded studies on the horizon, there is hope that CR will become a relatively more valued and utilized component of cardiovascular preventative care.
心脏康复（CR）转介是美国心脏协会和美国心脏病学会的 I 类心肌梗死后推荐，但转介率仍然低得惊人，心脏病专家是转介率最低的罪犯之一。本文旨在综述 CR 的演变及其已确立的益处，以及转介和利用不佳的原因。
CR 是心血管疾病（CVD）的二级预防计划，它于 20 世纪 70 年代首次作为急性心肌梗死后的医院内运动计划启动，但后来演变为更广泛的心血管疾病患者的综合多学科计划。CR 在几十年的时间里都能降低死亡率和发病率，即使介入和药物心血管治疗得到改善，患者也相对更加稳定。尽管这是一个基于证据的临床标准，但 CR 的转介和参与率却低得令人不安。为了提高转介率，改善当代护理环境中的护理，CR 的方法正在发生变化。创新包括将 CR 从医院扩展到远程和混合模式，同时仍然纳入运动训练、降低风险因素以及教育，以及行为和社会心理支持。尽管如此，为了增加所有年龄段、财务状况、种族和性别的参与，仍有许多挑战需要克服。随着新的绩效指标以及 NIH 资助研究的数量不断增加，人们希望 CR 将成为心血管预防保健中更有价值和更常用的组成部分。
