TY - JOUR T1 - Cardiac rehabilitation: JF - British Journal of General Practice JO - Br J Gen Pract SP - 677 LP - 679 DO - 10.3399/bjgp08X342219 VL - 58 IS - 555 AU - Hugh JN Bethell AU - Robert JP Lewin AU - Hasnain M Dalal Y1 - 2008/10/01 UR - http://bjgp.org/content/58/555/677.abstract N2 - The authors of the National Institute for Health and Clinical Excellence (NICE) guideline for the management of secondary prevention following an acute myocardial infarction reviewed the evidence for cardiac rehabilitation and declared that its implementation should be a key priority.1 For nearly 30 years reviews by official bodies around the world have reached the same conclusion, that cardiac rehabilitation is an essential treatment for patients' wellbeing and also saves lives in a highly cost-effective manner. The most recent of numerous meta-analyses included 8940 patients from 48 randomised controlled trials of cardiac rehabilitation and showed a reduction in overall mortality of 20% and of cardiac mortality of 26% over 3 years.2 Despite the ever growing pile of reports, despite a massive increase in cardiological funding in secondary care, and despite the fact that it is probably the only form of ‘chronic disease management’ with a proven costeffectiveness, the majority (around 70%) of patients do not receive rehabilitation following myocardial infarction3 and recent funding changes are threatening the current provision. If the NICE target that every suitable myocardial infarction patient receives rehabilitation is to be met, then primary care may, for the reasons given below, needs to be in the driving seat.Cardiac rehabilitation is a treatment for patients following a new cardiac event or a step change in clinical condition; for example, following myocardial infarction, coronary revascularisation, cardiac transplantation, new onset or worsening of angina or heart failure, or implantation of a cardiac defibrillator.4 There are four phases: phase 1 is the period in hospital following the acute event; and phase 2 is the period at home before the start of phase 3, which traditionally has been a supervised outpatient programme. The aims of the rehabilitation programme are to return the patient to full functioning … ER -