From Cardiac Rehabilitation to Ambulatory Preventive Care: The Swiss Way

Abstract

Over the last years, cardiac rehabilitation services have expanded their indication to include not just patients after myocardial infarction or surgery, but also a variety of non-acute cardiovascular disease (CVD) states like stable coronary artery disease, peripheral artery disease, neurovascular disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome and diabetes mellitus. In 2015, 110 ambulatory cardiovascular prevention and rehabilitation programs existed in Switzerland: 57 for cardiac, 17 for peripheral artery disease and 36 for diabetes rehabilitation. Rehabilitative and preventive care is provided by a team of professionals including preventive cardiologists, exercise experts (physiotherapists and sports scientists), nurses, dieticians, psychologists, occupational therapists and social services experts. It seems reasonable to combine professional efforts by integrating prevention and rehabilitation for all high risk patients. The creation of cardiovascular prevention centers, which bring together professionals and patients in dedicated hospital or community settings is a promising first step. In 2015, 7 centers have been recognized as specialized cardiovascular prevention centers in Switzerland. Furthermore, community-based and patient-centered activities and programs have a great potential to contribute to improved preventive care and to support long-term adherence. A closer cooperation between professional preventive teams in prevention centers and the primary care physicians has a great potential to contribute to close this gap and to provide seamless primary and secondary preventive care for patients in need and the society.