The European Society of Cardiology (ESC) has released its first dedicated guidelines on cardiac rehabilitation, published online in the European Heart Journal. The newly compiled document outlines the benefits, optimal components, implementation methods, and patient groups for whom rehabilitation should be recommended. ESC Guidelines Task Force chair Professor Maria Bäck from Sahlgrenska University Hospital in Gothenburg, Sweden, noted that the care program offers positive effects surpassing medication or surgery alone.
First Dedicated ESC Guidelines for Cardiac Rehabilitation Published
The guidelines are scheduled to be presented at ESC Congress 2026. Task Force chair Associate Professor Matthias Wilhelm from Bern University Hospital in Switzerland pointed out that while people are living longer, those extra years are frequently marked by ill health and poor physical and mental functioning. The guidelines cover sustainable lifestyle changes, the importance of taking prescribed medications, and individualizing rehabilitation plans through shared decision-making between patients and healthcare professionals. Patient representatives actively contributed to the task force.
Expanding Recommendations Beyond Traditional Heart Conditions
While cardiac rehabilitation is widely recommended after heart attacks and for heart failure, the new guidelines specify that advantages extend to additional patient populations. These include individuals with congenital heart disease, atrial fibrillation, and those recovering from heart valve replacement. Furthermore, the guidelines encompass cancer patients who have undergone anticancer therapies linked to heart side effects.
Despite being highly effective, cardiac rehabilitation remains underused across many countries. The document highlights a lack of reimbursement as a barrier to access and implementation, even though evidence demonstrates that cardiac rehabilitation is cost-effective and frequently cost-saving by reducing healthcare resource utilization.
Insights from the Remote Exercise SWEDEHEART Study
Complementing the publication of the new guidelines, results from the Remote Exercise SWEDEHEART study were presented during a Hot Line session at ESC Congress 2026. The registry-based, cluster-randomised crossover trial investigated patients aged 18 to 79 years with type 1 myocardial infarction across 23 Swedish centers over 15-month intervention periods.
The study compared remotely delivered exercise against center-based programs. Findings indicated that the proportion of patients completing the full exercise program was similar—13.8% during the intervention period and 13.6% during the control period. Professor Bäck stated that remote exercise was clearly utilized when available, accounting for approximately 38% of recorded exercise sessions during intervention periods, while 62% took place at healthcare centers.
Both groups improved their physical capacity with no significant differences. Safety monitoring revealed small numbers of serious events, with exercise-related serious adverse events occurring at a rate of 0.47 per 1,000 patient-hours for center-based exercise and 0.17 per 1,000 patient-hours for remote exercise. Researchers concluded that remotely delivered exercise-based cardiac rehabilitation serves as a valuable patient-centered option rather than a complete replacement for center-based programs.
Implementation and Digitally Enhanced Care Options
The guidelines outline practical information regarding delivery modes. For selected patients, digitally enhanced home-based cardiac rehabilitation—incorporating remote monitoring and teleconsultations with healthcare professionals—offers increased convenience and reduced healthcare costs compared to traditional hospital programs.
However, participation barriers remain multifaceted. According to News-Medical, physical uptake hurdles extend beyond travel limitations to include co-existing diseases, language barriers, socioeconomic factors, and varying levels of digital health literacy. Follow-up analyses from a wider group of patients within the SWEDEHEART registry are ongoing.
