Physician support for outpatient cardiac rehabilitation groups Position paper of the German Cardiac Society (DGK) in cooperation with the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR)

Phase III outpatient cardiac rehabilitation groups (cardiac rehab groups) are crucial for effective cardiovascular prevention and rehabilitation. The need to increase the number of these groups is limited by the decreasing availability of physicians as it has been mandated that all cardiac rehab groups have to be supervised by physicians. Study data have shown that during the last decades the risk of serious events during exercise training of cardiovascular patients has decreased due to the improvements in cardiovascular medicine. Therefore, physician support for cardiac rehab groups should now depend on risk stratification. In the "standard cardiac rehab group" physician attendance is not necessary. The group is supervised by a qualified non-physician exercise therapist. It is mandatory that during training in these groups an automated external defibrillator (AED) is available and an immediate emergency call to the emergency medical services is possible. In the "cardiac rehab group with increased need for support" attendance of a physician is required. This group is reserved for patients with risk criteria, such as angina pectoris or dyspnea during exercise. Patients that fulfill the criteria for the novel "heart failure rehab groups" are excluded from this risk stratification. These new high-risk cardiac rehab groups have recently been introduced into clinical practice in 2020 and are attended by specially trained cardiac group leaders and physicians. It has been calculated that following the proposed risk stratification approximately 50% of the cardiac rehab group patients will no longer need supervision by a physician. It is expected that implementation of this model into practice will increase the number of cardiac patients who will participate in cardiac rehab groups without a loss of safety or effectiveness.