Cardiac Rehabilitation: Indications, Benefits, and New Approaches

Victoria L. Boggiano, MD, MPH
Rana Alkhaldi, MD
Amir H. Barzin, DO, MS

American Family Physician. 2025;112(3):272-277.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Cardiac rehabilitation consists of comprehensive risk factor reduction with demonstrated effectiveness in combating cardiovascular disease. The American Heart Association defines cardiac rehabilitation as a supervised program to improve cardiovascular health through a combination of exercise, education, and emotional counseling for those who have had a myocardial infarction, heart failure, angioplasty, or heart surgery. Cardiac rehabilitation programs involve evaluations by a team of specialists, structured exercise, and lifestyle risk factor modification, and a focus on long-term goals to improve overall health and reduce coronary heart disease morbidity and mortality. Family physicians play a vital role in ensuring that patients are connected to and complete cardiac rehabilitation training because the program remains underused nationwide. After a coronary heart disease event and cardiac rehabilitation, these programs continue to support patients by helping them adhere to lifestyle modifications.

VICTORIA L. BOGGIANO, MD, MPH, is an assistant professor in the Department of Family Medicine, University of North Carolina at Chapel Hill.

RANA ALKHALDI, MD, is an assistant professor in the Department of Family Medicine, University of North Carolina at Chapel Hill.

AMIR H. BARZIN, DO, MS, FAAFP, is an associate professor in the Department of Family Medicine, University of North Carolina at Chapel Hill.

Address correspondence to Victoria L. Boggiano, MD, MPH, at boggiano@email.unc.edu.

Author disclosure: No relevant financial relationships.

  1. 1.Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ. 2015;351:h5000.
  2. 2.American Heart Association. What is cardiac rehabilitation? Updated April 24, 2024. Accessed September 18, 2024. https://www.heart.org/en/health-topics/cardiac-rehab
  3. 3.Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC Expert Panel. J Am Coll Cardiol. 2021;77(11):1454-1469.
  4. 4.Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1-12.
  5. 5.Stephens MB. Cardiac rehabilitation. Am Fam Physician. 2009;80(9):955-959.
  6. 6.Santiago de Araújo Pio C, Beckie TM, Varnfield M, et al. Promoting patient utilization of outpatient cardiac rehabilitation: a joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement. Int J Cardiol. 2020;298:1-7.
  7. 7.Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024;149(8):e347-e913.
  8. 8.Kallio V, Hämäläinen H, Hakkila J, et al. Reduction in sudden deaths by a multifactorial intervention programme after acute myocardial infarction. Lancet. 1979;2(8152):1091-1094.
  9. 9.Ades PA, Keteyian SJ, Wright JS, et al. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clin Proc. 2017;92(2):234-242.
  10. 10.Li S, Fonarow GC, Mukamal K, et al. Sex and racial disparities in cardiac rehabilitation referral at hospital discharge and gaps in long-term mortality. J Am Heart Assoc. 2018;7(8):e008088.
  11. 11.Brown TM, Hernandez AF, Bittner V, et al. Predictors of cardiac rehabilitation referral in coronary artery disease patients: findings from the American Heart Association's Get With The Guidelines program. J Am Coll Cardiol. 2009;54(6):515-521.
  12. 12.Keshvani N, Subramanian V, Wrobel CA, et al. Patterns of referral and postdischarge utilization of cardiac rehabilitation among patients hospitalized with heart failure: an analysis from the GWTG-HF Registry. Circ Heart Fail. 2023;16(8):e010144.
  13. 13.Sun EY, Jadotte YT, Halperin W. Disparities in cardiac rehabilitation participation in the United States: a systematic review and meta-analysis. J Cardiopulm Rehabil Prev. 2017;37(1):2-10.
  14. 14.Mansour AI, Nuliyalu U, Thompson MP, et al. Out-of-pocket spending for cardiac rehabilitation and adherence among US adults. Am J Manag Care. 2024;30(12):651-657.
  15. 15.Rodrigo SF, Van Exel HJ, Van Keulen N, et al. Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned. Int J Cardiol Heart Vasc. 2021;36:100858.
  16. 16.Clark AM, King-Shier KM, Thompson DR, et al. A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral. Am Heart J. 2012;164(6):835-45.e2.
  17. 17.Centers for Medicare and Medicaid Services. Billing and coding: frequency and duration for cardiac rehabilitation and intensive cardiac rehabilitation. Revised January 1, 2025. Accessed May 9, 2025. https://www.cms.gov/medicare-coverage-database/view/article.aspx
  18. 18.Lakhani F, Racette SB, Park LK, et al. Prospective study of the impact of outpatient intensive cardiac rehabilitation on diet quality, health-related quality of life, and cardiovascular health indices. Am J Cardiol. 2023;192:60-66.
  19. 19.Dibben G, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021(11):CD001800.
  20. 20.Dibben GO, Dalal HM, Taylor RS, et al. Cardiac rehabilitation and physical activity: systematic review and meta-analysis. Heart. 2018;104(17):1394-1402.
  21. 21.Adams BJ, Carr JG, Ozonoff A, et al. Effect of exercise training in supervised cardiac rehabilitation programs on prognostic variables from the exercise tolerance test. Am J Cardiol. 2008;101(10):1403-1407.
  22. 22.Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011;162(4):571-584.e2.
  23. 23.Kanaoka K, Iwanaga Y, Nakai M, et al. Outpatient cardiac rehabilitation dose after acute coronary syndrome in a nationwide cohort. Heart. 2022;109(1):40-46.
  24. 24.Damluji AA, Forman DE, Wang TY, et al. Management of acute coronary syndrome in the older adult population: a scientific statement from the American Heart Association. Circulation. 2023;147(3):e32-e62.
  25. 25.Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119.
  26. 26.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032.
  27. 27.Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019(1):CD003331.
  28. 28.Sachdev V, Sharma K, Keteyian SJ, et al. Supervised exercise training for chronic heart failure with preserved ejection fraction: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2023;81(15):1524-1542.
  29. 29.Scrutinio D, Guida P, Ruggieri R, et al. Prognostic value of functional capacity after transitional rehabilitation in older patients hospitalized for heart failure. J Am Geriatr Soc. 2022;70(6):1774-1784.
  30. 30.Adachi T, Iritani N, Kamiya K, et al. Prognostic effects of cardiac rehabilitation in patients with heart failure (from a multicenter prospective cohort study). Am J Cardiol. 2022;164:79-85.
  31. 31.Squires RW, Bonikowske AR. Cardiac rehabilitation for heart transplant patients: considerations for exercise training. Prog Cardiovasc Dis. 2022;70:40-48.
  32. 32.Sibilitz KL, Berg SK, Rasmussen TB, et al. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart. 2016;102(24):1995-2003.
  33. 33.Amedro P, Gavotto A, Huguet H, et al. Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial. Eur Heart J. 2024;45(16):1458-1473.
  34. 34.Risom SS, Zwisler AD, Rasmussen TB, et al. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: results of the randomized CopenHeartRFA trial. Am Heart J. 2016;181:120-129.
  35. 35.McDonagh ST, Dalal H, Moore S, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2023(10):CD007130.
  36. 36.Keteyian SJ, Grimshaw C, Ehrman JK, et al. The iATTEND trial: a trial comparing hybrid versus standard cardiac rehabilitation. Am J Cardiol. 2024;221:94-101.
  37. 37.Reid RD, Dafoe WA, Morrin L, et al. Impact of program duration and contact frequency on efficacy and cost of cardiac rehabilitation: results of a randomized trial. Am Heart J. 2005;149(5):862-868.
  38. 38.Li R, Wang M, Chen S, et al. Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: a systematic review and network meta-analysis. Int J Nurs Stud. 2024;158:104845.
  39. 39.Shields GE, Wells A, Doherty P, et al. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. 2018;104(17):1403-1410.
  40. 40.Thomas RJ. Cardiac rehabilitation—challenges, advances, and the road ahead. N Engl J Med. 2024;390(9):830-841.
  41. 41.American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs 5th ed. Human Kinetics; 2020.
  42. 42.Winnige P, Vysoky R, Dosbaba F, et al. Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases. World J Clin Cases. 2021;9(8):1761-1784.
  43. 43.Servey JT, Stephens M. Cardiac rehabilitation: improving function and reducing risk. Am Fam Physician. 2016;94(1):37-43.
  44. 44.Myneni P, Bodduluri M, Gadde ST, et al. Effectiveness of cardiac rehabilitation in enhancing clinical outcomes for coronary artery disease: a systematic analysis. Cureus. 2024;16(9):e69224.
  45. 45.Wells A, Reeves D, Capobianco L, et al. Improving the effectiveness of psychological interventions for depression and anxiety in cardiac rehabilitation: PATHWAY–a single-blind, parallel, randomized, controlled trial of group metacognitive therapy. Circulation. 2021;144(1):23-33.
  46. 46.Richards SH, Anderson L, Jenkinson CE, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2017(4):CD002902.
  47. 47.Widmer RJ, Allison TG, Lennon R, et al. Digital health intervention during cardiac rehabilitation: a randomized controlled trial. Am Heart J. 2017;188:65-72.
  48. 48.Luijk A, Mortensen SR, Hamborg TG, et al. The effectiveness of digital health interventions for the maintenance of physical activity following cardiac rehabilitation: a systematic review and meta-analysis. Digit Health. 2024;10 : 20552076241286641.

Copyright © 2026 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. See permissions for copyright questions and/or permission requests.