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Clinical Review

Cardiac rehabilitation

BMJ 2015; 351 doi: (Published 29 September 2015) Cite this as: BMJ 2015;351:h5000
  1. Hasnain M Dalal, honorary clinical associate professor1,
  2. Patrick Doherty, chair in cardiovascular health, director of the National Audit of Cardiac Rehabilitation, deputy head of department (research)2,
  3. Rod S Taylor, chair of health services research, academic lead for Exeter Clinical Trials Support Network, NIHR senior investigator3
  1. 1University of Exeter Medical School (primary care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK
  2. 2Department of Health Sciences, University of York, York YO10 5DD, UK
  3. 3Institute of Health Research, University of Exeter Medical School, Exeter EX1 2LU, UK
  1. Correspondence to: H M Dalal hmdalal{at}

The bottom line

  • Globally, the prevalence of coronary heart disease and heart failure is increasing, and there is some evidence of the health benefits of cardiac rehabilitation

  • Effective implementation of cardiac rehabilitation after acute coronary syndrome, coronary revascularisation, and heart failure has remained suboptimal, with overall participation rates <50% over recent decades despite international recommendations

  • International guidelines now recommend that cardiac rehabilitation programmes include health education and psychological counselling

  • Patients should be offered a choice of community based and home based cardiac rehabilitation programmes to fit their needs and preferences

  • Clinicians should endorse cardiac rehabilitation for patients with a recent diagnosis of coronary heart disease or heart failure

Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease, which includes components of health education, advice on cardiovascular risk reduction, physical activity and stress management. Evidence that cardiac rehabilitation reduces mortality, morbidity, unplanned hospital admissions in addition to improvements in exercise capacity, quality of life and psychological well-being is increasing, and it is now recommended in international guidelines.1 2 3 4 5 6 This review focuses on what cardiac rehabilitation is and the evidence of its benefit and effects on cardiovascular mortality, morbidity and quality of life.

Sources and selection criteria

RST is a member of the Cochrane Heart Group and has led and conducted several systematic reviews of cardiac rehabilitation. We searched the Cochrane database ( for cardiac rehabilitation and equivalent terms. We identified current national and international clinical guidelines based on systematic reviews and meta-analyses. We referred to the National Audit of Cardiac Rehabilitation annual report, which was led by PD, and the British Heart Foundation’s website for statistics on coronary heart disease in the UK. We also consulted recent review articles from the UK, US, Canada, and Australia. We have included topics that would be of interest to hospital doctors and …

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