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Practice Clinical Updates

Virtual and in-person cardiac rehabilitation

BMJ 2021; 373 doi: (Published 03 June 2021) Cite this as: BMJ 2021;373:n1270
  1. Hasnain M Dalal, associate professor1 2,
  2. Patrick Doherty, chair in cardiovascular health, director of the National Audit of Cardiac Rehabilitation3,
  3. Sinead TJ McDonagh, postdoctoral research fellow in cardiovascular care2,
  4. Kevin Paul, patient representative4,
  5. Rod S Taylor, professor of population health research5
  1. 1University of Exeter Medical School, Royal Cornwall Hospital, Truro, UK
  2. 2Primary care Research Group, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
  3. 3Department of Health Sciences, University of York, York, UK
  4. 4REACH-HF Patient and Public Involvement Group, c/o Research & Development, Royal Cornwall Hospitals NHS Trust, Truro, UK
  5. 5MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to H Dalal h.dalal{at}

What you need to know

  • Most eligible patients with coronary heart disease and heart failure do not participate in cardiac rehabilitation. Covid-19 has exacerbated this, with a substantial drop in the number of patients participating

  • Home and telehealth based interventions are increasingly being used as alternatives to traditional centre based rehabilitation programmes

  • Outcomes for patients participating in home based rehabilitation compare favourably with centre based programmes in terms of hospitalisations, quality of life, and cost

  • Telehealth based interventions are promising, but some patients may find these interventions challenging

  • Novel ways of delivering rehabilitation have been employed during the covid-19 pandemic, including hybrid models that are likely to be offered as alternatives to centre based rehabilitation in future, enabling greater patient choice and greater uptake of cardiac rehabilitation

Before the covid-19 pandemic, 100 000 people were admitted to hospital with heart attacks and approximately 200 000 were diagnosed with heart failure annually in the UK.1 An estimated 7.4 million people in the UK live with cardiovascular diseases, and this is likely to increase with improved survival following coronary heart disease and an ageing population.1

A 2020 European position paper, in keeping with other national and international guidelines,23 stated that “comprehensive cardiac rehabilitation has been recognised as the most cost effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease.”4 Benefits include improvements in morbidity, hospital admissions, physical activity, exercise capacity, psychological wellbeing, and health related quality of life.34567891011 Patient groups set to benefit are categorised, by evidence level, in box 1. To achieve these benefits, it is recommended that all core components of cardiac rehabilitation (box 2) are included in a comprehensive programme.4 Guidelines from the UK also advocate long term strategies to promote secondary prevention in primary care and …

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