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Over the past decades the medical care of the patient with cardiovascular disease (CVD)
has shown an impressive development, with marked positive consequences for mortality,
morbidity, and the quality of life of coronary patients. This improvement has
profoundly changed the arena in which cardiac rehabilitation (CR) has been acting
over the past 40 years. The younger patient from the 1970s with uncomplicated myocardial
infarction without ventricular dysfunction was joined in the early 1990s by patients
with advanced heart failure, and the transition continues: modern cardiac rehabilitation
is increasingly faced with a generation of patients who have been diagnosed and
adequately treated early with minimal residual cardiovascular damage. The focus of
CR is changing from physical rehabilitation to lifestyle counseling. But this development
is paradoxical indeed: with more cardiac patients surviving the acute event, the numbers
of elderly patients have grown and the total need for comprehensive CR has not
been reduced. The elderly were rarely enrolled in the early years of exercise-based
training programs. Therefore, this large population presents a new challenge, especially
as CR has proved to be particularly beneficial for patients with congestive heart
failure.
Other factors play a role in the changing arena for CVD prevention and rehabilitation:
the worldwide pandemic of obesity is expected to again raise the numbers of young
cardiac patients and the disease is now extending into other parts of the globe. Thus
CVD will remain the main cause of premature death in the first half of this century. Preventive
public health measures are required. The relative weight of different risk factors
appears to be altering, with disturbances in the psychosocial sphere becoming more
important.With new diagnostic methods atherosclerosis can be detected well before an
acute event,which creates a greater demand for preventive cardiology, as has been appreciated
in the 2003 European Guidelines on Cardiovascular Prevention. Prevention and
rehabilitation are gradually becoming a united and intertwined multidisciplinary
service. |
