Long-term comprehensive cardiac care -- the perspectives and tasks of cardiac rehabilitation

Restoration of the patient's physiological, psychological and social capabilities should improve the quality of survival. It is paramount that a multifactorial disease is treated by a multifactorial approach. Until the end of the 1960s rehabilitation was identified with physiotherapy and physical training. It was only during the past two decades that a comprehensive long-term approach was systematically accepted, mainly that physical training is only one therapeutic modality which can be applied in selected groups of coronary patients, and that rehabilitation procedures must include risk factor modifications, change in life habits, and other conservative and/or surgical therapeutic measures. In programmes which are conducted under directed supervision, either in specific cardiac rehabilitation units, or under clinical conditions (particularly in the early rehabilitation phase II), one of the most important goals of CCC is close follow-up, which enables the early detection of deterioration and timely initiation of effective therapeutic measures. Randomized trials have so far produced some meaningful results concerning mortality, while non-randomized controlled trials have also shown a lower mortality in intervention groups. Rehabilitation programmes have to be considered as an integral part of CCC. The early initiation of such comprehensive interventions in the acute phase I, convalescent phase II and maintenance phase III after myocardial infarction may have contributed to the decline in mortality in some countries. Quality of survival can certainly be enhanced by comprehensive rehabilitation; whether or not survival itself can be influenced still remains to be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)