Should all cardiac patients be offered the choice of cardiac rehabilitation?

To determine whether cardiac rehabilitation services are beneficial to patients and cost-effective. Several recent publications are reviewed. The first of these, 'Cardiac Rehabilitation. Clinical Practice Guideline No. 17', is itself a review of original published research: 900 scientific reports were examined by a multidisciplinary panel and 334 of these were considered to be of sufficient scientific merit to be used as the references for the guideline. The other publications discussed are: The American Heart Association Consensus Panel Statement, 'Preventing heart attack and death in patients with coronary disease', the American College of Cardiology's recommendations on 'Matching the intensity of risk factor management with the hazard for coronary disease events' and Recommendations of the Task Force of the European Society of Cardiology, the European Atherosclerosis Society and European Society of Hypertension, 'Prevention of coronary heart disease in clinical practice'. Cardiac rehabilitation brought about substantial benefits in risk factor profiles, including improvement in exercise tolerance, blood lipids, psychosocial well-being, and reduction in cigarette smoking and stress levels. In addition there was well-documented proof of improvement of pathophysiological measures, such as relief of symptoms, less progression and greater regression of disease and a reduction in mortality. As an intervention, cardiac rehabilitation was shown to be as cost-effective as many pharmacological regimens and surgical interventions. The evidence in support of cardiac rehabilitation is so overwhelming that all patients should be educated about this form of treatment and have the ultimate choice of accepting or rejecting it.