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← Cardiology indexChapter sections
Role and principlesAssessment and patient selectionBaseline assessmentInterventionsTargets, monitoring and follow-upSpecial situationsCommon pitfallsQuestionsSources
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Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.

Cardiac rehabilitation

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull

Role and principles

Identify eligible patients, make a timely referral and understand the personalised assessment, delivery and outcome measures of UK cardiovascular rehabilitation.

Cardiac rehabilitation is a coordinated clinical pathway, not simply a supervised exercise class. It turns the acute event into a structured programme for recovery, risk reduction and return to everyday roles.

The initial assessment sets personalised goals and exercise prescription while identifying medical instability, mood symptoms, social barriers and rehabilitation preferences. Final assessment compares outcomes and hands a sustainable plan to primary care and the patient.

Equity is an active design requirement: flexible venues and times, language support, accessible formats, home options and re-offer improve participation among groups historically less likely to attend.

Key points

  • Offer cardiac rehabilitation with an exercise component to all people after MI irrespective of age; ACS, PCI/CABG and chronic heart failure are NHS England priority cohorts when capacity is constrained.
  • Begin the rehabilitation conversation during admission and invite the person to a session that starts within 10 days after discharge following MI.
  • NHS England expects provider contact within five working days of referral and a holistic initial assessment within 10 days of receipt of referral.
  • A complete programme combines tailored aerobic and resistance exercise with education, risk-factor management, medicines optimisation, psychological support and long-term self-management.
  • Offer in-person, remote or hybrid delivery according to preference and access; digital exclusion is a reason to adapt, not to exclude.
  • Assess comorbidity and clinical stability before exercise; unstable angina, decompensated heart failure or uncontrolled arrhythmia needs medical review before progression.
  • Re-contact people who do not start or who drop out, and record baseline and final outcomes rather than counting referral alone.

Assessment and patient selection

Priority eligibility

Acute coronary syndrome, PCI/CABG and chronic heart failure are priority NHS cohorts; stable angina, valve intervention, ICD/CRT, transplant and VAD patients may also be offered rehabilitation where capacity allows.

Unsafe-to-progress features

New or unstable chest pain, decompensated congestion, syncope, uncontrolled arrhythmia, marked resting hypotension/hypertension or acute systemic illness needs clinical reassessment before exercise.

Psychological need

Anxiety, depression, fear of recurrence, trauma symptoms and loss of confidence can be as limiting as physical deconditioning and must be assessed directly.

Access barrier

Transport, work, caring duties, language, disability, rurality, digital exclusion, cost and cultural needs should trigger adaptation of mode or timing.

Failure to engage

A missed start or dropout is a cue for supportive re-contact and problem-solving, not automatic discharge from the pathway.

Baseline assessment

  1. 01
    Holistic baseline assessmentFirst step
    Why
    Define goals, comorbidity, function, preferences, social context and readiness for change.
    Interpretation and limitations
    The result determines delivery mode, supervision and which core components need greatest emphasis.
  2. 02
    Resting BP, pulse/rhythm, symptoms and volume status
    Why
    Check medical stability before exercise and guide medicines optimisation.
    Interpretation and limitations
    Unexpected instability requires medical review; stable abnormalities inform an individual exercise prescription.
  3. 03
    Functional-capacity assessment
    Why
    Set a safe aerobic/resistance starting point and measure progress.
    Interpretation and limitations
    Use a validated service method such as walking or exercise testing with symptom and exertion monitoring; compare like with like at completion.
  4. 04
    Lipids, glycaemic status, weight/body composition and smoking assessment
    Why
    Target modifiable vascular risk.
    Interpretation and limitations
    Results should lead to named goals and NICE-aligned treatment, not generic lifestyle advice.
  5. 05
    Validated psychosocial screening

Interventions

01First-lineIdentify and referFirst stepFirst lineEligible cardiovascular event, procedure or diagnosis+
  1. 1Introduce rehabilitation before discharge or at diagnosis and explain exercise, education, medical and psychological components.
  2. 2Send a direct referral with diagnosis, procedure, ventricular function, medicines, complications, mobility/communication needs and contact details.
  3. 3For MI, invite to a programme starting within 10 days after discharge; the NHS England service standard is provider contact within five working days of referral.
  4. 4Give a route for the patient and primary-care team to chase a missing contact.
02Second-lineAssess and prescribeSecond lineFirst rehabilitation contact+

Targets, monitoring and follow-up

  • Attendance, mode offered, time from referral to contact/assessment and reasons for non-start or dropout.
  • Symptoms, BP, pulse/rhythm, perceived exertion and adverse responses during exercise progression.
  • Functional capacity and personalised goal attainment from baseline to final assessment.
  • Smoking, physical activity, diet/body composition, BP, lipids and glycaemic control.
  • Anxiety/depression or other psychosocial outcomes and onward-referral completion.
  • Medicine reconciliation, adherence, adverse effects and completion of planned cardioprotective titration.

Special situations

Referral is not uptake

Audit contact, assessment, start and completion separately; each stage has different barriers.

Home is a valid setting

A validated facilitated home or remote programme can provide comprehensive rehabilitation when it includes exercise, education, psychological support and follow-up.

Exercise is prescribed

Intensity and supervision follow assessment, comorbidity and symptoms; generic advice to 'walk more' is not a rehabilitation prescription.

Re-offer matters

People's work, recovery and confidence change; a decline or early dropout should not close the door to later participation.

Return to roles is clinical

Work, caring, driving, sexual activity and travel questions belong in rehabilitation and may need individual cardiology or DVLA/CAA advice.

Common pitfalls

  1. 01

    Describing rehabilitation as an exercise class and omitting medicines, risk factors and psychosocial care.

  2. 02

    Excluding a person because of age, comorbidity, disability, language or inability to use digital tools.

  3. 03

    Starting exercise progression despite unstable angina, decompensated heart failure or unexplained syncope.

  4. 04

    Sending a referral without clinical details or any mechanism to confirm contact.

  5. 05

    Measuring success only by sessions attended rather than baseline-to-final outcomes and a long-term plan.

Practice

Two practice questions

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Question 1 of 2
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CardiologyOriginal SBA

Timing after MI

A medically stable patient is being discharged after an uncomplicated MI. Which rehabilitation timing best matches NICE guidance?

Choose one answer, then submit
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NHS England: Commissioning standards for cardiovascular rehabilitationDecember 2024 eligibility, access, pathway and quality standards.
  • NICE NG185: Acute coronary syndromesPost-MI offer, timing and programme components.
  • NICE NG106: Chronic heart failurePersonalised exercise-based rehabilitation for heart failure.
  • NICE QS99: Secondary prevention after myocardial infarctionQuality standards for post-MI care.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateComplete draftClinical stateAwaiting reviewJurisdictionUnited Kingdom
Why
Identify anxiety, depression, distress and social support needs.
Interpretation and limitations
Positive screens require discussion and the appropriate NICE mental-health or urgent safeguarding route.
  • 06
    Final reassessment
    Why
    Measure clinical, functional, behavioural and patient-reported change.
    Interpretation and limitations
    Use the findings to create a long-term plan and communicate unresolved risks to primary/specialist care.
    • 1
    Complete the holistic assessment within 10 days of referral receipt, including clinical stability, function, mood, risk factors, social determinants and preference.
  • 2Agree measurable goals and a tailored aerobic/resistance exercise plan with appropriate supervision.
  • 3Select in-person, remote or hybrid delivery and provide language, disability or digital adaptations.
  • 4Optimise medicines and risk factors through the relevant NICE pathways and communicate changes to the responsible prescriber.
    • 03Third-lineDeliver and reviewThird lineMedically stable participant+
    1. 1Deliver exercise, education, diet/weight, tobacco cessation, psychosocial support, medical risk management and long-term strategy components.
    2. 2Monitor symptoms and exertion at each contact; stop and clinically assess new chest pain, presyncope, dangerous rhythm or decompensation.
    3. 3AlternativeRe-contact non-starters and dropouts using motivational, practical support and alternative delivery modes.
    4. 4Repeat baseline outcome measures at completion and provide a shared discharge/self-management plan.
    04EscalationClinical deterioration or complex needEscalationUnstable symptoms, high-risk exercise response or unmet specialist need+
    1. 1Pause progression and arrange urgent same-day assessment for possible ACS, decompensated HF, syncope or unstable arrhythmia; use emergency services when indicated.
    2. 2Seek cardiology, heart-failure, electrophysiology, diabetes, mental-health, smoking-cessation or social-care input as the identified problem requires.
    3. 3After stabilisation, reassess rather than permanently exclude and agree a modified supervised pathway.
    4. 4Record the event, response and revised exercise limits across the care team.