Cardiac rehabilitation 2012: advancing the field through emerging science.

B urgeoning research in the field of preventive cardiology over the past 20 years has fostered the evolution of cardiac rehabilitation programs, once limited to exercise training, into comprehensive secondary prevention centers. Data demonstrate that contemporary cardiac rehabilitation/ secondary prevention (CR/SP) programs reduce cardiovascu-lar risk and event rates, foster healthy behaviors, and promote active lifestyles. 1,2 Accordingly, every recent major evidence-based guideline from the American Heart Association (AHA) and the American College of Cardiology Foundation regarding the management and prevention of coronary heart disease provides a class 1 level recommendation (ie, procedure/ treatment should be performed/administered) for referral to a CR/SP program 3,4 for those patients with recent myocardial infarction (MI) or acute coronary syndrome, chronic stable angina, or heart failure, or for those patients following coronary artery bypass surgery or percutaneous coronary intervention. CR/SP programs are also indicated for those patients following valve surgery or cardiac transplantation. 3 Emerging science will undoubtedly advance the field further, as clinicians translate data to foster future change. In this brief review, we provide a focused update on recently published studies that have great potential to move the field of cardiac rehabilitation forward. These studies address the following topic areas: utilization of CR/SP services and associated survival benefits; novel exercise protocols; and emerging applications in the management of diabetes mellitus, heart failure, pulmonary hypertension, peripheral arterial disease, and congenital heart disease. Despite the wealth of evidence supporting the proven benefits of CR/SP programs, the services are greatly underutilized. Of eligible patients, only 14% to 35% of heart attack survivors and 31% of patients after coronary artery bypass surgery participate in CR/SP programs. 5,6 To reduce the gap between indication and implementation, a joint American Association of Cardiovascular and Pulmonary Rehabilitation/American College of Cardiology Foundation/AHA committee has recently revised the performance measures for referral to these services. 3 The newly published AHA Presidential Advisory on the referral, enrollment, and delivery of CR/SP programs highlights the patient-oriented, medical, and healthcare system factors associated with suboptimal participation. 2 In particular, patients who are women, belong to ethnic minorities , are elderly, and have low socioeconomic status have lower participation rates than white men and represent specific high-risk groups to be targeted for referral. 1 Healthcare system factors interfering with utilization include proximity and accessibility of services incorporating home-based exercise programs together with facility-based supervised training sessions can help improve participation (see later for discussion on home-based …