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Comparative Effectiveness Review of Intensive Cardiac Rehabilitation Programs for Coronary Artery Disease

February 22, 2018

Health Problem: Coronary artery disease (CAD) is responsible for serious harms, including myocardial infarction (MI) and death. It is characterized by atherosclerosis, the thickening and hardening of arteries due to plaque buildup. Atherosclerosis results from the accumulation of fatty deposits and cell products, including calcium and other crystalized materials. Over time, atherosclerosis in the vessels that supply blood to the heart can prevent the heart from receiving enough oxygenated blood, causing CAD.

Technology Description: Intensive cardiac rehabilitation (ICR) programs are comprehensive, long-term programs involving medical evaluation, exercise, cardiac risk factor modification, education, and counseling for patients with chronic or post-acute cardiovascular disease. Sessions are more frequent and longer than conventional cardiac rehabilitation (CCR) programs. ICR is intended for primary and secondary prevention of cardiac events. Programs include Dr. Ornish’s Program for Reversing Heart Disease, the Pritikin Program, and Benson-Henry Institute Cardiac Wellness Program.

Controversy: Whether ICR leads to better health outcomes than less costly CCR is unclear. Coverage has been challenged as unwarranted, under the contention that evidence does not demonstrate improvements in health.

Key Questions:

For adults with CAD:

  • Does participation in an ICR program decrease the incidence of serious cardiac events or mortality?
  • Does participation in an ICR program decrease the risk of serious cardiac events or mortality?
  • Is participation in an ICR program safe?
  • Have definitive patient selection criteria been established for ICR programs?