Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs

utpatient cardiac rehabilitation/secondary prevention programs are characterized by comprehensive services, including medical evaluation, prescribed exercise, and car- diovascular disease risk factor modification through evidence-based pharmacological management of risk factors and behavioral interventions. This multifactorial process is designed to limit the adverse physiological and psychological effects of cardiac illness, to reduce the risk of sudden death or reinfarction, to control cardiac symptoms, to stabilize or reverse the atherosclerotic process, and to enhance the pa- tient's psychosocial and vocational status.1 Provision of these services is physician directed and implemented by a team of healthcare professionals that may include nurses, exercise physiologists, dietitians, health educators, behavioral medi- cine specialists, and other healthcare professionals.2 Appropriate patient/physician interaction during cardiac rehabilitation is important from a clinical and a regulatory perspective. In practice, the cardiac rehabilitation team inter- acts with a patient multiple times per week, providing an opportunity to facilitate management of blood pressure and lipids, glycemic control, smoking cessation, medication com- pliance, and adherence to lifestyle modification. Although long-term management of these issues is the responsibility of the primary care physician and/or cardiologist, cardiac reha- bilitation provides an opportunity for concentrated risk factor modification during a critical period for the patient with coronary heart disease. By working closely with referring physicians, the cardiac rehabilitation team can assist the patient in reaching target goals more efficiently. The medical director is ultimately responsible for ensuring that systems are in place to facilitate this process and that appropriate communication with referring physicians is maintained. This document will serve as a guide for the medical director of an outpatient cardiac rehabilitation/secondary prevention program to link the clinical aspects of physician involvement to the provision of services by program staff while maintaining compliance with regulatory requirements. It is not meant to replicate the excellent reviews, practical guidelines, and scientific statements published elsewhere3-7 that describe the rationale for and detailed structure of comprehensive cardiac rehabilitation programs. Rather, it provides an overview of specific responsibilities for the medical director of an outpatient cardiac rehabilitation and secondary prevention program. Patient participation in this programming is frequently the first step in developing a lifelong commitment to the secondary prevention of coronary heart disease.