ESC releases first cardiac rehab guidelines

The European Society of Cardiology (ESC) published its first standalone Guidelines on cardiac rehabilitation online in the European Heart Journal on August 30, 2026. The guidelines will be presented at the ESC Congress 2026 on August 31.

Cardiac rehabilitation is a personalized program to help patients manage cardiac disease and recover from a heart event or operation. Until now, recommendations were scattered across guidelines for specific conditions like heart attacks. For the first time, international experts have compiled comprehensive evidence on its benefits, components, delivery, and target patients.

"Cardiac rehabilitation is one of the most effective treatments in cardiovascular care," said ESC Guidelines Task Force chair Professor Maria Bäck from Sahlgrenska University Hospital in Sweden. She noted it provides positive effects beyond medication or surgery alone. Despite growing cardiovascular disease rates, the therapy remains underused across Europe and elsewhere.

The new document aims to change that. It provides practical implementation details previously lacking.

Core components and patient focus

Delivered by a multidisciplinary team, an effective program combines several core components. These include exercise training, emotional support, and personalized education on sustainable lifestyle changes and medication adherence.

Each patient's plan should be individualized. It must consider their needs, preferences, and personal circumstances. Development occurs through shared decision-making between the patient and health professionals.

Patient representatives actively contributed to the task force. "One of the clearest messages from patients is that cardiac rehabilitation is about far more than physical recovery," said Task Force chair Professor Dominique Hansen from Hasselt University in Belgium.

He explained it represents the journey back to everyday life after a major cardiac event. The program helps patients regain confidence, independence, and trust in their bodies. It also provides families with knowledge and support during a highly stressful period.

Broad benefits and implementation barriers

The guidelines recommend cardiac rehabilitation after a heart attack and for heart failure patients. They also highlight benefits for other groups.

These include patients with congenital heart disease or atrial fibrillation. Those who have undergone heart valve replacement also benefit. So do patients with cancer who received anticancer therapies associated with heart side effects.

A lack of reimbursement is a key barrier to access in some countries. This persists despite evidence consistently showing cardiac rehabilitation is cost-effective and often cost-saving. Reduced use of healthcare resources and fewer life-years spent in poor health drive the savings.

The guidelines note that digitally enhanced home-based programs can reduce costs. These include remote monitoring and teleconsultations. For selected patients, this approach is more convenient than traditional hospital-based programs.

Associate Professor Matthias Wilhelm, another Task Force chair from Bern University Hospital in Switzerland, linked the guidelines to broader health goals. "Although people are now living longer, these extra years are often lived in ill health," he said. Improving rehabilitation is a key aim of the World Health Organization and is anchored in the EU Safe Heart Plan.

A tailored program can improve heart health and reduce the risk of another cardiac event. It also improves general physical and mental well-being. A patient version of the guidelines is also available.