Cardiac rehabilitation is a medically supervised program designed to help heart patients recover quickly and improve their overall physical and mental functioning. The goal of these programs is to significantly reduce the risk of another cardiac event, and to prevent the worsening of a heart condition already present. The programs can also greatly improve a patient’s outlook on life and provide the support needed to make important lifestyle changes. Social support and optimism have long been considered important factors in heart patient survival.

In 2006, the Centers for Medicare and Medicaid Services expanded the list of approved conditions for which a cardiac rehabilitation program is covered. These conditions are also covered by many private insurers. They include:

• Recent heart attack, within the previous 12 months
  
  
• Coronary bypass surgery
  
  
• Stable angina, or chest pain that occurs at predictable times, such as exercise, and is typically caused by coronary artery disease
  
  
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• Heart valve repair or replacement surgery

Although heart failure is currently not covered by Medicare or most private insurers, studies have confirmed that cardiac rehabilitation can also benefit these patients. Ongoing research in this area may soon add heart failure to the list of covered conditions. In any event, if a heart failure patient is able to afford cardiac rehabilitation on their own, and they have their physician's approval, there is some proven benefit. In addition, patients with peripheral arterial disease may benefit from cardiac rehabilitation, although it won't likely be covered by insurance and is not covered by Medicare.

Heart patients who begin the program while in the hospital usually start by working on regaining basic skills, such as getting out of bed and going to the bathroom by themselves. Once out of the hospital, heart patients work on getting stronger and learning how to avoid future heart-related problems. A program of cardiac rehabilitation is specifically designed to fit each individual, and the length of the program can vary from weeks to months, depending on that person’s unique needs. Typical programs last between 8 and 12 weeks and meet three times weekly for monitored exercise. This may vary.

At the outset of the outpatient phase of a cardiac rehabilitation program, the health care team will assemble an extensive medical history of the patient and take various measurements, including cholesterol levels, blood pressure testing, diabetes status, body mass index and other indicators of heart health. These measures will be continually monitored throughout the rehabilitation program in an effort to monitor cardiac risk factors. The goal of cardiac rehabilitation is to lower the risk of a cardiac event by favorably altering individual risk factors and thereby increase quality of life for heart patients. Typically, cardiac rehabilitation programs have both short-term and long-term goals.

In some cases, medications may be recommended as part of the program. The most common medications include:

• Aspirin or other antiplatelet agents.
  
  
• Beta blockers, to protect the heart and/or aid in the control of blood pressure.
  
  
• Cholesterol-reducing medications, such as statin medications.
  
  
• ACE inhibitors and/or angiotensin receptor blockers (ARBs),  which are used to lower the blood pressure. ARBs are a newer class of pressure-lowering drugs, typically prescribed for individuals who have diabetes and/or those who cannot take ACE inhibitors.

Rehabilitation should not be administered to patients with severe or unstable symptoms, such as uncontrolled heart failure, unstable angina, the acute phase of the heart attack, severe, persistent heart arrhythmias and shock. In these conditions, patients may be considered for rehabilitation after control, stabilization or reversal of the condition has taken place, and in some cases by providing a definite treatment such as bypass surgery or coronary angioplasty.

Education and/or counseling programs within cardiac rehabilitation tend to focus on topics such as:

• Depression and other feelings often experienced by people with heart problems or following surgery
  
  
• Getting back to work
  
  
• New physical limitations (e.g., weight restrictions – the maximum amount of weight that a physician decides a patient can lift)
  
  
• Stress management techniques that help people relax instead of getting overly tense, frustrated or angry
  
  
• Identification of coronary risk factors and advice on how to reduce them
  
  
• The heart-damaging effects of smoking and strategies for quitting
  
  
• The importance of a heart-healthy diet and dietary strategies for reducing fat and cholesterol levels
  
  
• Weight loss
  
  
• Social support for making necessary lifestyle changes (e.g., quitting smoking)

One of the most important parts of any cardiac rehabilitation program is exercise. Recent research has shown that heart attack patients who participated in a cardiac rehabilitation program that included exercise were 50 percent more likely to survive the next three years after their heart attack. Furthermore, those who exercise have significantly lower readmission rates to the hospital in comparison with those patients who do not exercise. Because exercise is such a critical part of cardiac rehabilitation, this topic is discussed in detail below.