Cardiac Rehabilitation Programs

M ore than one of every five persons in the United States has cardiovascular disease. Despite the declining mortality rate due to cardiovascular illness observed since 1950,43% of all deaths are currently attributed to cardiovascular causes. Mortality among the 1.5 million persons who have a myocardial infarction (MI) accounts for more than 485 000 deaths annually. The morbidity and subsequent disability incurred from coronary artery disease (CAD) alone have far-reaching medical and socioeconomic implications. The nearly 468 000 coronary revascularization procedures performed each year, together with the associated hospital stays, medications, medical personnel, and health care facility charges, will result in an estimated cost in 1994 of more than $56 billion for CAD.' Remarkably, more than 14% of this cost is due to lost productivity from temporary or permanent disability.' Continued major efforts in primary prevention are critical to reduce overall incidence of CAD. Nonetheless, continued advances in medical and surgical techniques combined with effective and focused programs in cardiac rehabilitation are needed to manage the burgeoning manifestations and consequences of overt CAD. Cardiac rehabilitation combines prescriptive exercise training with coronary risk factor modification in patients with established heart disease. The goals of cardiac rehabilitation are to improve functional capacity, alleviate or lessen activity-related symptoms, reduce disability,2 and identify and modify coronary risk factors in an attempt to reduce subsequent morbidity and mortality due to cardiovascular illness. The ultimate goal of cardiac rehabilitation is to restore and maintain an individual's optimal physiological, psychological, social, and vocational status.2 Cardiac rehabilitation and efforts targeted at exercise, lipid management, hypertension control, and smoking cessation can reduce cardiovascular mortality,3'4 improve functional capacity,5-16 attenuate myocardial ischemia,17-'9 retard the progression and foster the reversal of coronary atherosclero-