Background

Heart Disease Burden

Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disease burden globally. CVD resulted in >1.1 million hospitalisations in 2015-16 and incurs the highest level of health care sector expenditure in Australia.Over 65,000 Australians experience an acute coronary event (heart attack or unstable angina) each year3 and importantly, many are preventable.

With an aging population, more people surviving initial events, and an epidemic of lifestyle-related health problems, the health burden is escalating globally. Most patients now survive an initial myocardial infarction (MI), have a short stay in-hospital and are discharged with minimal physical morbidity

Thus, improving post-discharge care through secondary prevention strategies (healthy living, adherence to medicines) is a current national and international priority.

Importance of history

Understanding the historical context underscores the need to reform CHD management in light of societal changes (eg. cultural, linguistic and geographical diversity and proliferation of technology) and medical and surgical advancements (Fig). Modern day “rehabilitation” was born at a time when bed rest and physical inactivity were recommended for people with heart disease.

Most (70-80%) heart disease secondary prevention programs today continue to follow the 50 year old model despite fundamental changes in society and medical care.

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