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Cardiac rehabilitation has been shown to improve exercise tolerance and symptomatology in patients experiencing angina or heart failure and reduce long term mortality after myocardial infarction, with a good cost-effectiveness ratio. In addition to these ‘hard’ endpoints, cardiac rehabilitation improves the patient's quality of life and risk factor profile through a multifactorial intervention. Indeed, cardiac rehabilitation is no longer restricted to physical reconditioning, but should now be understood as the long term care of cardiac patients through a personalised and periodically updated programme. The components of a comprehensive cardiac rehabilitation programme should comprise risk stratification of the patient, physical reconditioning programmes, secondary prevention and vocational counselling. This article is a synthesis of the principal guidelines and recently published recommendations on cardiac rehabilitation. It focuses on the practical modalities of a cardiac rehabilitation programme, the setting up of the multidisciplinary team, the different facilities according to local possibilities and the patient's clinical status, the prescription of a personalised programme, safety measures and emergency procedures. Together with these general considerations, special populations which constitute new but growing indications for cardiac rehabilitation are addressed: patients with heart failure, elderly patients and women, who need specific management. In the future, cardiac rehabilitation should be characterised by a likely increase in its indications because of: a predicted high prevalence of coronary artery disease (due to an aging population and an improvement in survival after a cardiac event) despite a lower mortality rate; an expansion of the indications in both low and high risk patients. In low risk patients, the goals of cardiac rehabilitation will be to prevent further progression of coronary atheroma and preserve ventricular function by preventive measures such as lifestyle and medical treatment. The needs of high risk patients (who are essentially heart failure patients) are the restoration of autonomy, when lost, and a better quality of life through the improvement of exercise capacity: those patients who were formerly excluded from cardiac rehabilitation programmes are in fact those who are now deriving the greatest benefit from exercise training. Owing to the proven benefits of this new concept of the multifactorial approach, cardiac rehabilitation has, nowadays, become an integral part of the treatment of cardiac patients. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the effects of rehabilitation in 46 consecutive three-vessel coronary disease patients who were considered to have no possibility of revascularization; there were 45 males and one female (mean age58) sent in the third week after acute myocardial infarction (N=31) or after unstable angina (N=15). Left ventricular ejection fraction (EF) was normal in 50% of the patients, but 15% had an EF≤0.30. Three patients could not begin their rehabilitation because of unstable angina (N=2) or severe pulmonary oedema (N=1). After a 4-week rehabilitation programme, the comparison of stress tests revealed an increase in functional capacities (maximal work-load = 103.6±27 W before rehabilitation, 126.4±31 W after rehabilitation, P<0.001), and an improvement of the ischaemic threshold [82 ± 32 W before rehabilitation, 91±31 W after rehabilitation, P≤0.05].During long-term follow up [20.8 months], four patients died of cardiac events [8.7%]; all of them had an EF<0.45. Among the 42 living patients 61.9% were asymptomatic, 28.7% had exertional angina, and 9.4% had cardiac complications, and coronary surgery was performed in two cases with good results. The level of return to work was 85% with the mean delay of 1.7 months after rehabilitation. So, rehabilitation in three-vessel coronary disease patients is safe under medical control; improvements in exertional capacities are obvious and give the patients a better self confidence as assessed by the good score of return to work after rehabilitation. [ABSTRACT FROM PUBLISHER]

The aim of the study was to assess the role of the occupational medicine specialist in improving return to work (RTW) after coronary bypass graft (CABG) surgery, with an early intervention in the rehabilitation programme of the patients. There were 57 patients (56 male, 1 female, mean age was 50.7 years), sent for rehabilitation 22 days after surgery (49% of them had a prior myocardial infarction, and the ejection fraction (EF) was ≥0.55 in 67%, 0.30

The clinical and coronary angiographic features of 35 patients who survived the acute phase of a myocardial infarction that occurred while they were practising sports were studied. 97 p. 100 of the patients were male. Mean age was 42.8 years (range 26-71 years), 60 p. 100 being over 40. All but 2 patients had risk factors, the most important of which were tobacco smoking (constant among young subjects) and high blood cholesterol level. In 1/3 of the cases the infarction was preceded by symptoms. 69 p. 100 of the patients were correctly trained. IN 46 p. 100 of the patients the signs of infarction appeared at the end of the physical exertion. Thirteen sports were concerned, notably football (9), tennis (7), cycling (5) and running (5). Contributing factors associated with the way physical exercise was performed with the environment or with the subject's general condition were often present. During a mean follow-up period of 25.3 months, 2 patients were lost sight of and 2 died, one of them of cardiac disease; 71 p. 100 remained asymptomatic. All patients underwent coronary angiography which showed coronary thrombosis in 60 p. 100 of the cases (100 p. 100 when angiography was performed at a very early stage and 33 p. 100 when it was performed more than 15 days after the infarction). One single vessel was involved in 40 p. 100 of the cases and several vessels in 34 p. 100. Angiography yielded normal results in 26 p. 100 of the patients, all of them aged less than 45 years.(ABSTRACT TRUNCATED AT 250 WORDS)