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In this patient population exercise-based cardiac rehabilitation is recommended as an effective means to achieve a healthy lifestyle and manage risk factors (class I A), as far as to reduce disease recurrence and the atherosclerotic process. 11. Importantly, there is still considerable potential to further reduce cardiovascular morbidity and mortality by increasing uptake and fully integrating secondary prevention and cardiac rehabilitation. The coincidence is increasingly seen in the context of a ‘cardiopulmonary continuum’ rather than being simply attributed to shared risk factors such as smoking.145 This leads to a relevant proportion of cardiac patients with COPD, currently around 6% to 20% in contemporary European cardiac rehabilitation programmes.105,110 Advanced COPD stages are associated with a deterioration of exercise capacity, cachexia and skeletal muscle dysfunction, comparable to patients with heart failure.146 COPD patients in groups B to D will benefit from pulmonary rehabilitation to improve dyspnoea, health status and exercise tolerance and to reduce exacerbations and hospitalizations.146 COPD patients with concomitant cardiac diseases can be integrated into cardiac rehabilitation programmes, adapted to the requirements of the underlying pulmonary disease and group. Atherton, JJ, Sindone, A, De Pasquale, CG. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: A systematic review and meta-analysis, Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: The SAINTEX-CAD study, The longterm effects of a randomized trial comparing aerobic interval versus continuous training in coronary artery disease patients: 1-year data from the SAINTEX-CAD study. Data from the ALPHA study registry, Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy, High-intensity interval training in cardiac resynchronization therapy: A randomized control trial, Exercise rehabilitation for chronic heart failure patients with cardiac device implants, Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: A systematic review, Fifth INTERMACS annual report: Risk factor analysis from more than 6,000 mechanical circulatory support patients. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care, A retrospective multicenter study on long-term prevalence of chronic pain after cardiac surgery, Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial, Cardiac Rehabilitation for Transcatheter Aortic Valve Replacement, Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: Predictors of functional and psychocognitive recovery, Aftercare of patients after MitraClip® implantation. Following the evolution of guidelines, this updated position paper has replaced the previous chapter on stable coronary artery disease and elective coronary angioplasty, now referring to CCS.7 For cardiac rehabilitation purposes (Table 3), this referral group mainly includes patients with ‘stable’ anginal symptoms (or atypical symptoms such as dyspnoea), symptomatic patients >1 year after initial diagnosis or revascularization, and patients with angina and suspected vasospastic or microvascular disease. As a chronic condition, it is never too late to start a secondary prevention programme with a target of a longer sustainability (phase III). Istituti Santa Maria. cognitive function, sureness of movement) in this population. The following sections give information on specific clinical conditions. Dickstein, K, Cohen-Solal, A, Filippatos, G. Ibanez, B, James, S, Agewall, S, Antunes, MJ.

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