Cardiovascular diseases remain one of the leading causes of morbidity and mortality worldwide. Acute conditions, such as myocardial infarction, or chronic ones, such as coronary artery disease (CAD), require not only emergency treatment but also long-term, comprehensive rehabilitation. Cardiological sanatoriums play a key role in this process, offering specialized programs aimed at restoring heart function, improving overall condition, and preventing recurrent events.
What is cardiac rehabilitation and why is it important?
Cardiac rehabilitation (CR) is a multidisciplinary program designed for patients with cardiovascular diseases. It includes physical training, risk factor modification, patient education, and psychological support, complementing standard pharmacotherapy [7]. The main goal of CR is to improve disease prognosis, enhance quality of life, and help patients return to full activity.
Studies show that CR significantly improves the five-year prognosis in patients who have suffered an acute myocardial infarction (AMI) [2]. This is achieved by optimizing cardiovascular system function, strengthening muscles, and increasing endurance. Without adequate rehabilitation, the consequences of cardiac events can be lifelong, including a decrease in left ventricular ejection fraction and generalized hypokinesia [7].
Types and forms of cardiac rehabilitation: from hospital to home
Cardiac rehabilitation can be conducted in various formats. Traditionally, inpatient and outpatient phases are distinguished. Inpatient rehabilitation typically begins shortly after the patient's condition stabilizes in the hospital. However, in some countries, such as Japan, shorter hospital stays have led to a decrease in patient participation rates in outpatient CR [2].
In response to these challenges, new approaches are developing, such as home-based cardiac rehabilitation (HBCR). It can be an effective alternative to traditional programs, especially for patients with coronary artery disease and risk factors. A study showed that HBCR programs managed via smartphone or phone calls are not inferior to traditional exercises in improving cardiorespiratory and muscular endurance [1]. This includes metrics such as peak oxygen consumption (V̇O2 peak), as well as muscle strength test results (e.g., 30-second arm curls and chair stands) [1].
Sanatoriums and specialized rehabilitation centers often offer intensive inpatient or semi-inpatient programs that combine the benefits of a controlled environment with an individualized approach, ensuring a high level of participation and control.
Effectiveness of rehabilitation: improving prognosis and quality of life
A key indicator of cardiac rehabilitation effectiveness is the improvement of long-term prognosis. A retrospective multicenter cohort study conducted in Japan demonstrated that CR, both inpatient and outpatient, significantly improves the 5-year prognosis in patients who underwent AMI [2]. This underscores the importance of the continuity of the rehabilitation process.
In addition to improving survival, CR contributes to a significant increase in physical fitness. Patients report improvements in cardiorespiratory endurance, measured by peak oxygen consumption, and muscle strength [1]. These changes directly affect the ability to perform daily tasks and return to an active life.
An important aspect is also secondary prevention. Intensive low-density lipoprotein (LDL) cholesterol management immediately after an acute coronary syndrome (ACS) to a level below 70 mg/dL is critical for reducing the risk of recurrent cardiovascular events [3]. Comprehensive programs, such as the Nagasaki Secondary Prevention Clinical Pathway for Acute Myocardial Infarction (NASP), can be cost-effective in reducing the incidence of cardiovascular disease [3].
Innovative approaches and comprehensive treatment in a sanatorium
Modern cardiological sanatoriums integrate advanced methodologies and comprehensive approaches. For example, multi-component exercise programs similar to X-CircuiT, which have proven effective in home settings [1], can be successfully adapted for a controlled sanatorium environment. This allows for individualized workload and ensures safety.
Special attention is paid to integrative approaches. In one case study, it was shown that adding Ayurvedic methods to traditional cardiac rehabilitation after AMI helped improve heart function, opening prospects for broader application of complementary methods in specialized institutions [7].
An important part of comprehensive treatment is taking comorbid conditions into account. Mental disorders frequently coexist with cardiovascular diseases, complicating their diagnosis and treatment [8]. Sanatoriums offering a multidisciplinary approach can effectively manage these interrelated risks by providing psychological support and specialized therapy. This is especially relevant for patients with complex conditions, such as coronary artery disease with ectasia in antiphospholipid syndrome and thrombocytopenia, which requires extremely careful and conservative management [4].
Over the past two decades (2000–2023), there has been a decrease in the incidence and mortality of cardiovascular diseases, partly due to improvements in coronary care and treatment, including during the COVID-19 pandemic period [5]. Sanatoriums continue to build on these achievements by offering high-quality care.
Who is cardiac rehabilitation in a sanatorium indicated for?
Cardiac rehabilitation in a sanatorium is indicated for a wide range of patients:
- Patients who have suffered an acute myocardial infarction (AMI) [2, 7].
- Individuals with coronary artery disease (CAD) and its risk factors [1].
- Patients after heart surgeries (e.g., coronary artery bypass grafting, stenting).
- People with chronic heart failure.
- Patients in need of intensive correction of risk factors, such as high cholesterol [3], hypertension, diabetes mellitus.
- Patients with complex comorbid conditions requiring conservative and careful management, such as the combination of CAD with ectasia and antiphospholipid syndrome [4].
- Individuals with comorbid mental disorders that may worsen the course of cardiovascular diseases [8].
- Those seeking structured and controlled recovery, education on a healthy lifestyle, and prevention of recurrent cardiac events.
A cardiological sanatorium provides a unique opportunity for comprehensive recovery and prevention of cardiovascular diseases. The combination of qualified medical supervision, individually tailored physical loads, educational programs, and psychological support makes it an indispensable stage on the path to a long and healthy life.
Sources
- X-CircuiT versus traditional exercise in home-based cardiac rehabilitation for patients with coronary artery disease and risk factors: a randomized controlled non-inferiority trial. https://pubmed.ncbi.nlm.nih.gov/40947912/
- Impact of inpatient and outpatient cardiac rehabilitation on 5-year prognosis in patients with acute myocardial infarction. https://pubmed.ncbi.nlm.nih.gov/41642116/
- Cost-effectiveness analysis of implementing a secondary prevention clinical pathway for acute myocardial infarction in Nagasaki. https://pubmed.ncbi.nlm.nih.gov/41922279/
- Conservative management of coronary artery disease with ectasia in thrombocytopenia associated with antiphospholipid syndrome: a case report. https://pubmed.ncbi.nlm.nih.gov/40988824/
- Changes in coronary care for acute myocardial infarction over the last two decades (2000–2023) in Kaunas, Lithuania. https://pubmed.ncbi.nlm.nih.gov/42194923/
- Cardiac rehabilitation with conventional treatment plus Ayurvedic intervention after acute myocardial infarction helps improve heart function – a case report. https://pubmed.ncbi.nlm.nih.gov/42462398/
- Cardiovascular risks in mental disorders and psychiatric risks in cardiovascular disorders: implications for prevention and clinical management — a large-scale umbrella review including 76 meta-analyses. https://pubmed.ncbi.nlm.nih.gov/42470860/
Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional medical consultation. Always consult a specialist before starting any treatment or changing your current therapy.