However, in more recent times, there has been a shift toward a more home-based model of care. The delivery of CR to date has largely been center-based, either in hospitals or community centers. In 2012, a Heart journal editorial concluded that CR should not only focus on content such as CHD risk factor modification and medication adherence but should also focus on the delivery mechanisms, thereby offering a range of different delivery methods for people according to their preferences and needs and potentially addressing the issue of low levels of participation.

Results from a Cochrane systematic review revealed that common barriers to adherence to CR programs included accessibility and parking at local hospitals, a dislike of group environments and work or domestic commitments. Participation rates in CR are documented at less than 50% worldwide. Įven though CR has been shown to be effective, adherence to these programs is generally suboptimal. One of the most significant benefits of CR exercise training to participants is the improvement in aerobic capacity and cardiorespiratory fitness. CR has also been found to improve psychological well-being and to facilitate an improvement in quality of life. A US observational study (n=635 coronary heart disease patients) reported improvements in depression, anxiety, and hospital scores after CR. With respect to hospital admissions, a Cochrane review of 33 RCTs (n=4740 patients with heart failure) showed that CR reduced the risk of overall hospitalization (relative risk, RR=0.75, 95% CI 0.62-0.92 absolute risk reduction, ARR=7.1% number needed to treat, NNT=15) and hospitalization for heart failure (RR=0.61, 95% CI 0.46-0.80 ARR=5.8% NNT=18). In terms of mortality rates, a systematic review and meta-analysis of 34 RCTs (n=6111 myocardial infarction patients) showed that those who attended CR had a lower risk of all-cause mortality than non-attendees (odds ratio=0.74, 95% CI 0.58-0.95). The efficacy of standard CR has been extensively reviewed. Two systematic reviews of exercise-based CR, which included 48 randomized controlled trials (RCTs), showed a 20% reduction in all-cause mortality and a 27% reduction in cardiac mortality at 2 to 5 years. Cardiac rehabilitation (CR), which is used to reduce the impact of CVD and to promote healthy behaviors and active lifestyles for those with CVD, has been shown to improve physical health and decrease subsequent morbidity and mortality rates in CVD populations.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for 30% of global deaths and 48% of deaths in Europe.

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