EJPC @ a glance: focus issue on cardiac rehabilitation and education in preventive cardiology

This issue of the European Journal of Preventive Cardiology focuses on the latest developments in cardiac rehabilitation (CR) and education in preventive cardiology, highlighting new approaches to improve patients’ care and outcomes. The statement from the European Association of Preventive Cardiology (EAPC) ‘The future of education in preventive cardiology’ by Koskinas et al.1 emphasizes the essential role of continuous education in the evolving field of preventive cardiology. Cardiovascular disease remains the leading cause of death worldwide, and prevention is crucial to reducing this burden. However, the educational needs of professionals in the field of preventive cardiology have grown significantly due to advances in risk factor identification, early diagnosis, and intervention strategies. The EAPC calls for a structured, multi-level educational approach aimed at physicians and allied healthcare professionals. This includes core training for cardiologists, specialized training for preventive cardiologists, and expert-level instruction for those taking on leadership roles in this field. The statement stresses the use of novel educational tools such as e-learning platforms, blending traditional methods with digital innovations to improve accessibility and engagement. Additionally, there is an increased focus on interdisciplinary collaboration, to ensure that preventive cardiology is understood and applied by a range of healthcare providers beyond the traditional boundaries of cardiology. This educational framework is expected to continuously evolve to incorporate new research and technological advancements, with the ultimate goal of improving cardiovascular outcomes across Europe and beyond. In a study entitled ‘Accurate prediction equations for ventilatory thresholds in cardiometabolic disease when gas exchange analysis is unavailable: development and validation’, Milani et al.2 developed and validated predictive equations for determining heart rate (HR) at the first and second ventilatory thresholds (VT1 and VT2) in patients with cardiometabolic diseases (CMDs). Using a cross-sectional sample of 2868 CMD patients, the researchers derived HR equations based on cycle-ergometer cardiopulmonary exercise tests (CPETs) and adjusted the percentage of HR peak and HR reserve. The results demonstrated that these predictive equations significantly outperformed guideline-based methods in accuracy, reliability, and agreement. External validation confirmed their applicability for moderate-intensity exercise prescription when CPET is not feasible. These equations offer a practical alternative to CPET for improving exercise training outcomes in clinical settings, particularly in resource-limited environments, providing a more consistent and tailored approach to exercise prescription for CMD patients. In the report ‘Psychometric validation of the short version of the Information Needs in Cardiac Rehabilitation (INCR-S) scale through a first global assessment’, Ghisi et al.3 explored the development and validation of the INCR-S scale to assess patients’ informational needs during CR. Administered to over 1600 cardiac patients in 19 countries, the INCR-S scale demonstrated strong psychometric properties, including high internal reliability (Cronbach’s alpha = 0.97). The scale identified five key areas of patient information needs: (i) symptom response and medications; (ii) heart diseases, diagnostic tests and treatments; (ii) exercise and return to life roles/programmes to support; (iv) cardiovascular risk factors; and (v) healthy eating and psychosocial management. Findings revealed that the level of knowledge varied by region and income class, with higher levels in high-income countries. The study emphasizes the importance of individualized educational approaches in CR programmes globally, suggesting that addressing the most significant knowledge gaps could optimize patients’ outcomes. In a large French nationwide study entitled ‘Two-year prognosis and cardiovascular disease prevention after acute coronary syndrome: the role of cardiac rehabilitation—a French nationwide study’, Blacher et al.4 offer valuable insights into the long-term benefits of CR following acute coronary syndrome (ACS). Despite strong clinical guidelines advocating for CR, participation rates remain low, with only ∼22% of eligible patients in France receiving CR after ACS (Figure 1). The study highlights the significant advantages of CR, demonstrating that patients who undergo rehabilitation are more likely to adhere to secondary prevention therapies, maintain medication persistence, and have better long-term outcomes. The findings show that 2 years after ACS, patients who participated in CR had a substantially lower risk of rehospitalization and mortality compared with those who did not. The authors argue that increasing access to CR—through strategies such as home-based or tele-rehabilitation—could dramatically improve patient outcomes. This paper serves as a powerful reminder of the need to advocate for greater CR uptake, which remains underutilized despite its proven benefits. Central illustration of the article Two-year prognosis and cardiovascular disease prevention after acute coronary syndrome: the role of cardiac rehabilitation—a French nationwide study from Blacher et al.4 Kjesbu et al.5 report the ‘Health-related quality of life in elderly cardiac patients undergoing cardiac rehabilitation and the association with exercise capacity: the EU-CaRE study’ where they examined the relationship between exercise capacity and health-related quality of life (HRQoL), anxiety, and depression among elderly patients undergoing CR. Their study highlights the importance of physical activity for improving both physical and mental well-being in older cardiac patients, particularly in relation to their exercise capacity. The study followed 1633 patients aged 65 years and older, tracking their exercise capacity and self-reported HRQoL, anxiety, and depression over the course of a CR programme. Findings revealed that improvements in exercise capacity were significantly associated with better HRQoL and reductions in anxiety and depression, especially in men. Women, despite having higher percentages of predicted exercise capacity, reported lower HRQoL and higher levels of anxiety and depression at all time points. However, both men and women experienced improvements after completing the CR programme. This research emphasizes the critical role of exercise in enhancing the quality of life for elderly cardiac patients. It also highlights the need for sex-specific approaches to CR, as men and women responded differently to improvements in exercise capacity. The findings support the continuation and expansion of CR programmes for elderly populations, demonstrating that physical fitness plays a pivotal role in both physical and mental health recovery. Frailty status plays an important role in rehabilitation programmes. The systematic review and meta-analysis ‘Cardiac rehabilitation and frailty: a systematic review and meta-analysis’ by MacEachern et al.6 focuses on frailty in CR and its impact on patient outcomes. This systematic review and meta-analysis sought to quantify the prevalence of frailty among CR participants, track changes in frailty during CR, and explore the association between frailty and adverse outcomes such as hospitalization and mortality. The meta-analysis included data from 34 studies involving 19 360 participants, revealing that frailty is common, with prevalence rates ranging from 40% to 50% at CR admission. Frailty was associated with a significantly increased risk of mortality and worse physical health outcomes. However, CR participation led to notable improvements in frailty, particularly for those who were frailer at the time of admission. This study reinforces the importance of addressing frailty in CR programmes, especially as frail patients represent a high-risk group for adverse health outcomes. The findings suggest that CR can play a crucial role in mitigating frailty and improving physical health, making it a valuable intervention for older, frail populations. Given the high variability in frailty tools and CR designs across studies, the authors also call for more standardized approaches to measuring and addressing frailty within CR programmes. Along with other shorter reports and editorials, this issue of the European Journal of Preventive Cardiology underscores the critical role of CR and education in the evolving landscape of preventive cardiology. The studies presented highlight innovative approaches in cardiovascular risk prediction, patient education, and rehabilitation, with a strong focus on interdisciplinary collaboration and modernized educational tools. The findings emphasize the need for tailored rehabilitation programmes that address specific challenges, such as frailty and exercise capacity, particularly in elderly and high-risk populations. We hope this issue will interest readers by offering practical insights into the future of preventive cardiology and rehabilitation. By applying these new approaches in daily practice, healthcare professionals can improve patient care and help reduce the global impact of heart disease None. Not applicable.