Mandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of Cardiology

Cardiac rehabilitation (CR) is a multidisciplinary process for patients recovering after an acute cardiac event or with chronic cardiovascular disease that reduces mortality and morbidity and improves quality of life. It is considered a cost-effective intervention and is expressly indicated in the guidelines of the major medical societies. In Portugal, only 8% of patients discharged from hospital after myocardial infarction are included in CR programs. In Europe overall, the percentage admitted to CR programs is 30%, while in the USA it is 20-30%. In view of the underuse of CR in Portugal, we call the attention of the health authorities to the need to increase the number and national coverage of CR programs, while maintaining high quality standards. The aim is for all patients resident in Portugal who are eligible for CR programs to have the same opportunities for access and attendance. In order to preserve the benefits and safety of this intervention, CR needs to be performed according to international guidelines. The fact that various initiatives in this field have been developed by different professional groups, some of them non-medical, that do not follow the European guidelines, has prompted us to prepare a series of norms defining mandatory criteria for CR, based on current knowledge and evidence. In this way we aim to ensure that the required increase in the number of CR programs, linked in a national network of CR centers, does not detract from the need to maintain their efficacy and quality. These criteria should serve as the basis for the future accreditation of CR centers in Portugal. A reabilitação cardíaca é um processo multidisciplinar de recuperação do doente após evento cardiovascular agudo ou com doença cardíaca crónica, que conduz à redução da mortalidade e morbilidade e melhoria da qualidade de vida. Considera-se uma intervenção custo-eficaz com indicação formal expressa em recomendações das mais importantes sociedades científicas internacionais. Em Portugal, apenas 8% dos doentes com alta hospitalar após enfarte são incluídos em programas de reabilitação cardíaca. Na Europa, a percentagem de admissão nesses programas é em média de 30%, enquanto nos Estados Unidos da América esse percentual se situa entre 20-30%. Pela subutilização franca da reabilitação cardíaca em Portugal, chamamos a atenção das autoridades de saúde para a necessidade de aumentar o número e a distribuição dos programas de reabilitação cardíaca no território nacional e