Impact of left ventricular ejection fraction on the results of cardiac rehabilitation

In a wide range of cardiovascular conditions, cardiac rehabilitation is recommended by current guidelines [1, 2]. Ideally, the programme should be initiated before hospital discharge, should commonly continue with a 12-week centre-based programme, and should be maintained indefinitely by the patient. Exercise in a cardiac rehabilitation programme is associated with a low risk of complications and there is wide consensus on the benefits of cardiac rehabilitation. These include reduced mortality, lower risk of rehospitalisation, better control of risk factors, adoption of a healthier lifestyle and improved quality of life [1]. Of note, most of the evidence on these benefits is based on observational studies and most of these studies were published before current therapeutic and preventive options became available [3]. A recent analysis of randomised controlled trials into the effects of exercise-based cardiac rehabilitation versus a no-exercise control, whose participants were recruited after the year 2000, found no effect from cardiac rehabilitation on all-cause mortality or cardiovascular mortality [4]. There was a small overall reduction in hospital admissions. These findings have not yet been incorporated in guidelines. Nonetheless, even if mortality is shown not to be reduced by cardiac rehabilitation in the current era, the other benefits would still support current guideline-based recommendations