The rehabilitation phase

Preventive Cardiology and Cardiac Rehabilitation (CR) is the specialty of clinical cardiology dedicated to the care of post-acute and chronic heart disease patients. The goals are to improve quality of life and prognosis, clinical stability, optimization of pharmacological and non-pharmacologic therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions and adherence to therapy. The global mandate of CR has changed over time. From the acute intervention, we moved on to the care in the medium and long-term period.Despite its clear benefits and guideline recommendations, CR is still not fully considered within the cardiovascular landscape. Furthermore, the importance of CR at the clinical level and of the "health" gain of CR is little known by the beneficiaries themselves, i.e. patients on one side and the health system on the other. The main criticism is the low referral rate of cardiac patients to CR programs. In Italy, in Europe and in the USA it appears to be <30%. The challenge for CR is to work on the changes induced by epidemiology and the healthcare system needs. CR inpatient wards must be increasingly available and organized to acquire complex patients, often elderly and frail, up to the development of sub-intensive rehabilitation therapy units; in Italy, it is also necessary to develop outpatient pathways for patients of moderate-low complexity, in order to increase the referral rate to CR. Finally, integrating CR programs with long-term follow-up pathways of cardiac patients is a very important task, fully entering in the areas of e-Health and m-Health.