Cardiac rehabilitation into the new millennium

Coronary heart disease remains the commonest cause of death in Western society and the highest rates in the world are found in the British Isles. It is a major cause of death in Ireland, claiming approximately 7000 lives each year. Cardiac rehabilitation aims to restore the patient to an optimum level of recovery, and where possible to prevent coronary heart disease from progressing. Hospitalized patients with coronary heart disease who require rehabilitation are often provided with in-hospital cardiac teaching programmes, comprising health education aimed at lifestyle modification. The focus of education is mainly concerned with moderation of risk factors which, if adequately controlled, can assist in reducing patients' morbidity and mortality. These include smoking, hypertension, diabetes, elevated serum cholesterol, hypertension and obesity. The intended outcome of education in the area of risk factor management is to produce observable sustainable changes in patients' behaviour. Changes in lifestyle behaviour are aimed at reducing their risk of worsening disease, and improving their overall quality of life. However, the extent to which these programmes actually elicit behavioural changes is uncertain. Studies have demonstrated that patients' knowledge level increased following the implementation of a structured teaching programme, but this did not necessarily produce the changes required in lifestyle. Where behavioural changes have been observed, these are usually confined to one area, and is not sustained over time. The failure of current cardiac teaching programmes to elicit behavioural changes may be due to lack of individualized approach, and inappropriate timing of information. In addition, programmes often have not been structured to suit patients' individual needs. In-hospital education is essential for all cardiac patients. This needs to be structured, systematic and easily adaptable to suit individual requirements.