Standardization and quality improvement of secondary prevention through cardiovascular rehabilitation programmes in Europe: The avenue towards EAPC accreditation programme: A position statement of the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC)
Restricted accessResearch articleFirst published online 2020
Standardization and quality improvement of secondary prevention through cardiovascular rehabilitation programmes in Europe: The avenue towards EAPC accreditation programme: A position statement of the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC)
Despite the proven efficacy and cost-effectiveness of contemporary cardiovascular rehabilitation programmes, the referral to/uptake of and adherence to cardiovascular rehabilitation remains inadequate. In addition, heterogeneity persists amongst different cardiovascular rehabilitation centres in Europe, despite the available scientific documents describing the evidence-based rehabilitation format/content. This position statement was elaborated by the Secondary Prevention and Rehabilitation (SP/CR) section of EAPC. It defines the minimal and optimal cardiovascular rehabilitation standards. In addition, it describes the relevant quality indicators of cardiovascular rehabilitation programmes to date. Compliance of European cardiovascular rehabilitation centres with these standards will improve cardiovascular rehabilitation process standardization in Europe and hence increase the quality of cadiovascular rehabilitation programmes.
AbreuAMendesMDoresH, et al.
Mandatory criteria for cardiac rehabilitation. Rev Port Cardiol2018;
37: 36373.
3.
MampuyaWM.Cardiac rehabilitation past, present and future: An overview. Cardiovasc Diagn Ther2012;
2: 38–49.
4.
PiepoliMCorràUAdamopoulosS, et al.
Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery. Eur J Prev Cardiol2014;
21: 664–681.
5.
RauchBDavosCHDohertyP, et al.
Prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies – The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol2016;
23: 1914–1939.
6.
SalzwedelAJensenKRauchB, et al.
Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II). J Prev Cardiol. Epub on 23 February 2020. DOI: 10.1177/2047487320905719.
7.
AndersonLOldridgeNThompsonDR, et al.
Exercise-based cardiac rehabilitation for coronary heart disease. J Am Coll Cardiol2016;
67: 1–12.
8.
LongLMondiJRBridgesC, et al.
Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev2019;
1: CD003331
9.
TaylorRSLongLMordiIR, et al.
Exercise-based rehabilitation for heart failure. J Am Coll Cardiol2019;
7: 691–705.
10.
ScalviniSGrossettiFPaganoniAM, et al.
Impact of in-hospital cardiac rehabilitation on mortality and readmissions in heart failure: A population study in Lombardy, Italy, from 2005 to 2012. Eur J Prev Cardiol2019;
26: 808–817.
11.
HedbackBPerkJHornbladM, et al.Cardiac rehabilitation after coronary artery bypass surgery: 10-Year results on mortality, morbidity and readmissions to hospital. J Cardiovasc Risk2001;
8: 153–158.
12.
ShieldsGEWellsADohertyP, et al.Cost-effectiveness of cardiac rehabilitation: A systematic review. Heart2018;
104: 1403–1410.
13.
PiepoliMCorraUBenzerW, et al.
Secondary prevention through cardiac rehabilitation: From knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation.Eur J Prev Cardiol2010;
17: 1–17.
14.
KotsevaKWoodDDe BacquerD, et al.
Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey. Eur J Prev Cardiol2018;
25: 1242–1251.
15.
KotsevaKDe BackerGDe BacquerD, et al.
Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol2019;
26: 824–835.
16.
PioCSAChavesGDaviesP, et al.
Interventions to promote patient utilization of cardiac rehabilitation: Cochrane systematic review and meta-analysis. J Clin Med2019;
8: 1--19.
17.
Bjarnason-WehrensBMcGeeHZwislerAD, et al.
Cardiac rehabilitation in Europe: Results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil2010;
17: 410–418.
AbreuAPesahESuperviaM, et al.
Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries? Endorsed by the European Association of Preventive Cardiology. Eur J Prev Cardiol2019;
26: 1131–1146.
20.
PiepoliMFBinnoSCorràU, et al. On behalf of Committee on Exercise Physiology and Train of HFA of the ESC. Extra- HF survey: The first European survey on implementation of exercise training in heart failure patients. Eur J Heart Fail2015;
17: 631–638.
21.
DohertyPJSalmanAFurzeG, et al.
Does cardiac rehabilitation meet minimum standards: An observational study using UK national audit?Open Heart2017;
4: e000519.
DoranGT.There’s a S.M.A.R.T.way to write management’s goals and objectives. Manage Rev1981;
70: 35–36.
25.
SmithSCJrBenjaminEJBonowRO, et al.
AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 Update: A guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol2011;
58: 2432–2446.
26.
StegGJamesSKAtarD, et al.
ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J2012;
33: 2569–2619.
27.
MontalescotGSechtemUAchenbachS, et al.
2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J2013;
34: 2949–3003.
28.
YancyCWJessupMBozkurtB, et al.
2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol2013;
62: e147–e239.
29.
RoffiMPatronoCColletJ, et al.
2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J2016;
37: 267–315.
30.
PiepoliMFHoesAWAgewallS, et al.
2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J2016;
37: 2315–2381.
31.
PonikowskiPVoorsAAAnkerSD, et al.
2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J2016;
37: 2129–2200.
32.
StoutKKDanielsCJAboulhosnJA, et al.
2018 AHA/ACC guideline for the management of adults with congenital heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation2019;
139: e637–e697.
33.
National Institute for Health and Care Excellence (NICE). Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care. Clinical guideline, https:/www.nice.org.uk/guidance/cg108 (2018, accessed 3 May 2020)
34.
Sousa-UvaMNeumannFJAhlssonA, et al.;
ESC Scientific Document Group. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg2019;
55: 4–90.
35.
WilliamsBManciaGSpieringW, et al.
2018 ESC/ESH guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J2018;
39: 3021–3104.
36.
MachFBaigentCCatapanoAL, et al. ESC Scientific Document Group,
2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS), Eur Heart J 2020; 41: 111--188
37.
PonikowskiPAnkerSD, et al.
2019 Clinical practice update on heart failure 2019: Pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail2019;
21: 1169–1186.
38.
BaladyGJWilliamsMAAdesPA, et al.
Core components of cardiac rehabilitation/secondary prevention programs: 2007 Update. A scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation2007;
115: 2675–2682.
39.
PiepoliMConraadsVCorraU, et al.
Exercise training in heart failure: From theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail2011;
13: 347–357.
AdamopoulosSCorràULaoutarisID, et al.
Exercise training in patients with ventricular assist devices: A review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail2019;
21: 3–13.
42.
Introduction: Standards of Medical Care in Diabetes 2020. Diabetes Care 2020; 43(Suppl. 1): S1--S2.
43.
AmbrosettiMAbreuACorràU, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. Epub ahead of print 30 March 2020. DOI: 10.1177/2047487320913379.
44.
LewinterCDohertyPGaleCP, et al.
Exercise-based cardiac rehabilitation in patients with heart failure: A meta-analysis of randomised controlled trials between 1999 and 2013. Eur J Prev Cardiol2015;
22: 1504–1512.
45.
RosenbaumANKremersWKSchirgerJA, et al.
Association between early cardiac rehabilitation and long-term survival in cardiac transplant recipients. Mayo Clin Proc2016;
91: 149–156.
46.
AndersonLNguyenTTDallCH, et al.
Exercise-based cardiac rehabilitation in heart transplant recipients.Cochrane Database Syst Rev2017;
4: CD012264.
47.
SteinhausDALubitzSANoseworthyPA, et al.
Exercise interventions in patients with implantable cardioverter-defibrillators and cardiac resynchronization therapy: A systematic review and meta-analysis. J Cardiopulm Rehabil Prev2019;
39: 308–317.
48.
NielsenKMZwislerADTaylorRS, et al.
Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator.Cochrane Database Syst Rev2019;
2: CD011828.
49.
SibilitzKLBergSKTangLH, et al.
Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database Syst Rev2016;
3: CD010876.
50.
GoelKPackQRLahrB, et al.
Cardiac rehabilitation is associated with reduced long-term mortality in patients undergoing combined heart valve and CABG surgery. Eur J Prev Cardiol2015;
22: 159–168.
51.
RibeiroGSMeloRDDereszLF, et al.
Cardiac rehabilitation programme after transcatheter aortic valve implantation versus surgical aortic valve replacement: Systematic review and meta-analysis. Eur J Prev Cardiol2017;
24: 688–697.
52.
SchlittALubosEGuhaM, et al.
After care of patients after MitraClip implantation. Herz2017;
42: 176–185.
53.
FellJDaleVDohertyP.Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis. Open Heart2016;
3: e000369.
54.
SumnerJBöhnkeJRDohertyP, et al .
Does service timing matter for psychological outcomes in cardiac rehabilitation? Insights from the National Audit of Cardiac Rehabilitation. Eur J Prev Cardiol 2018; 25: 19--28.
55.
JohnsonDASacrintyMTGomadamPS, et al.
Effect of early enrollment on outcomes in cardiac rehabilitation. Am J Cardiol2014;
114: 1908–1911.
56.
MarzoliniSBlanchardCAlterDA, et al.
Delays in referral and enrolment are associated with mitigated benefits of cardiac rehabilitation after coronary artery bypass surgery. Circ Cardiovasc Qual Outcomes2015;
8: 608–620.
57.
HarrisKMAndersonDRLandersJD, et al.
Utility of walk tests in evaluating functional status among participants in an outpatient cardiac rehabilitation program. J Cardiopulm Rehabil Prev2017;
37: 329–333.
58.
AraújoCGSCarvalhoCTBarrosCL, et al.
Normatização dos equipamentos e técnicas da reabilitação cardiovascular supervisionada. Arq Bras Cardiol2004;
83: 448–452.
59.
SilvaAKBarbosaMPBernardoAF, et al.
Cardiac risk stratification in cardiac rehabilitation programs: A review of protocols. Rev Bras Cir Cardiovasc2014;
29: 255–265.
60.
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs-6th Edition. Human Kinetics, 4 Mar 2020.
61.
Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes -- 2020. Diabetes Care 2020; 43(Suppl 1): S32--S36.
62.
Lifestyle management: Standards of medical care in diabetes 2019. Diabetes Care2019; 42: S46–S60.
63.
Glycemic targets: Standards of medical care in diabetes. Diabetes Care2019;
42: S61–S70.
64.
ReibisRSalzwedelAAbreuA, et al.
The importance of return to work: How to achieve optimal reintegration in ACS patients. Eur J Prev Cardiol2019;
26: 1358–1369.
65.
ThomasRJBaladyGBankaG, et al.
2018 ACC/AHA clinical performance and quality measures for cardiac rehabilitation: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol2018;
71: 1814–1837.
66.
McKelvieRSHeckmanGABlaisC, et al.
Canadian Cardiovascular Society quality indicators for heart failure. Can J Cardiol2016;
32: 1038.e5–1038.e9.
67.
Grace S, Poirier P, Norris CM, et al. Pan-Canadian development of cardiac rehabilitation and secondary prevention quality indicators. Canadian Association of Cardiac Rehabilitation. Can J Cardiol 2014; 30: 945--948.
68.
CowieABuckleyJDohertyP, et al.
Standards and core components for cardiovascular disease prevention and rehabilitation. Heart2019;
105: 510–515.
