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Abstrak :
ABSTRAK
Di Indonesia, penyakit jantung yaitu penyakit jantung koroner menjadi penyebab

kematian tertinggi pada semua umur setelah stroke, yakni sebesar 12,9% menurut hasil

Survei Sample Registration System (Kemenkes, 2014). Penyakit Jantung pada tahun 2017

juga menempati urutan teratas dengan pembiayaan sebesar Rp 9.5 triliun yang ditanggung

oleh Pemerintah Indonesia melalui Badan Penyelenggara Jaminan Sosial (BPJS)

Kesehatan (Setkab, 2018). Dana tersebut digunakan untuk membiayai pengobatan baik

operasi, rawat inap dan rawat jalan pasien jantung di seluruh Indonesia. Masalah

kekambuhan dan kematian pasien jantung berkaitan dengan tingkat kepatuhan

pengobatan. Persepsi terhadap penyakit dikenal sebagai salah satu faktor penting yang

dapat dimodifikasi yang memiliki hubungan positif dengan kepatuhan pengobatan

(Maharjan, 2016). Namun persepsi terhadap penyakit hanya mampu menjelaskan namun

tidak memprediksi kepatuhan (Brandes & Mullan, 2014). Peneliti mengasumsikan

terdapat jalur mediasi antara pengaruh persepsi terhadap penyakit pada kepatuhan

pengobatan. Penelitian ini bertujuan untuk melihat bagaimana peran kecemasan yang

berfokus pada jantung dan kecenderungan depresi sebagai mediator dalam hubungan

pengaruh persepsi terhadap penyakit pada kepatuhan pengobatan pasien penyakit jantung.

Partisipan penelitian sebanyak 155 orang diberikan pengukuran menggunakan B-IPQ

(persepsi terhadap penyakit), CAQ (kecemasan yang berfokus pada jantung), PHQ-4

(kecenderungan depresi), MMAS-8 (kepatuhan minum obat), dan LAM (kepatuhan

perubahan gaya hidup). Hasil penelitian menunjukkan bahwa kecemasan yang berfokus

pada jantung berperan sebagai mediator dalam pengaruh persepsi terhadap penyakit pada

kepatuhan minum obat (p = 0.028) dan kepatuhan perubahan gaya hidup (p = 0.004.

Kecenderungan depresi berperan sebagai mediator dalam pengaruh persepsi terhadap

penyakit pada kepatuhan perubahan gaya hidup (p = 0.000). Sedangkan dalam pengaruh

persepsi terhadap penyakit pada kepatuhan minum obat, kecenderungan depresi tidak

berperan sebagai mediator (p = 0.184).<

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ABSTRACT
In Indonesia, heart disease which is coronary heart disease, is the highest cause of death

at all ages after a stroke, which is 12.9% according to Sample Registration System survey

result (Kemenkes, 2014). Heart Disease in 2017 ranks the top with funding of Rp 9.25

trilion borne by Indonesian Government through Badan Penyelenggara Jaminan Sosial

(BPJS) Kesehatan (Setkab, 2018). The fund are used to fund treatment for both surgery,

inpatient and outpatient cardiac patient throughout Indonesia. The problem of recurrence

and death of cardiac patient is related to the level of medication adherence. Illness

Perception is known as one of the important factor that can be modified which has a

positive relationship with medication adherence (Maharjan, 2016). Illness Perception

only able to explain but not to predict medication adherence (Brandes & Mullan, 2014).

The researcher assumes that there is a mediating pathway between the influence of illness

perception on medication adherence.This study aims to see how the role of heart focused

anxiety and depression tendency as a mediator in the relationship of illness perception

on medication adherence in heart disease patients. The study participants were 155 people

given measurement using B-IPQ (illness perception), CAQ (heart focused anxiety), PHQ-

4 (depression tendency), MMAS-8 (medication adherence), dan LAM (lifestyle

adherence). The result showed that heart-focused anxiety acted as a mediator in

relationship of illness perception on medication adherence (p = 0.028) and lifestyle

adherence (p = 0.004). Depression tendency acted as a mediator in relationship of illness

perception on lifestyle adherence (p = 0.000) but not in medication adherence (p = 0.184).

Abstrak :
Metode pengukuran kualitas hidup manusia yang terkait dengan kesehatan sudah berkembang selama ini di negara-negara maju. Pola pengukuran yang ada mencakup berbagai macam atribut yang dipergunakan untuk mengukur status kesehatan perorangan, yang secara umum melibatkan fungsi dari organ tubuh baik secara fisik maupun non fisik. Indonesia sebagai salah satu negara berkembang dengan berbagai macam jenis penyakit, teknik evaluasi Ekonomi Kesehatan yang menggunakan alat ukur kualitas hidup sangat jarang dilakukan di Indonesia. Terkait dengan hal tersebut, maka permasalahannya adalah : Belum diketahuinya aplikasi model HRQol pada pengukuran status kesehatan dari pasien penyakit jantung koroner di Indonesia. Kerangka konsep yang diajukan dimulai dengan studi literatur dan peer review dengan para ahli untuk membandingkan dan mengklasifikasikan alat ukur MacNew yang disesuaikan dengan kondisi pasien penyakit jantung di Indonesia. Dilakukan 2 kali uji coba pada pasien di RSUD Pasar Rebo yang kemudian menghasilkan 16 atribut yang valid dan reliabel, yaitu: pusing, kebahagiaan, kemandirian, kegiatan sosial, gangguan pernapasan, dada sakit, kaki sakit, olahraga/latihan terbatas, rendah diri, gelisah, tidak berharga, keterbatasan fisik, frustasi, proteksi, terbebani dan sosialisasi. Dilakukan pengukuran nilai utility yang didapat yaitu nilai rata-rata Utility untuk tiap atrbut adalah 40,51. Dengan Pearson Chi-square (p<0,05) terlihat bahwa atribut Sosialisasi memiliki korelasi terkuat dengan atribut-atribut lain yaitu: pusing, kebahagiaan, kemandirian, kegiatan sosial, gangguan pernapasan, dada sakit, kaki sakit, olahraga/latihan terbatas, rendah diri, gelisah, tidak berharga, keterbatasan fisik, frustasi, proteksi, terbebani. ......The human quality of life measurement methods related to health have been developed in many countries. Measurement patterns include a variety of attributes that are used to measure the health status of individuals, which generally involve the functions of organs, both physical and non physical. Indonesia as a developing country with many kinds of disease, Health Economic evaluation techniques that use instruments to measure the quality of life is very rarely done in Indonesia. Related to that, then the problem is not many application model: HRQol in the measurement of health status of the patients with coronary heart disease in Indonesia. The proposed draft framework began with the study of literature and peer review by experts to compare and classify MacNew measurement tool based on patient's heart disease conditions in Indonesia. Done 2 time trials on patients in Pasar Rebo Hospital with 16 attributes valid and reliability, including: dizziness, happiness, independence, social events, respiratory disorder, chest pain, leg pain, sports/exercise limited, low self-esteem, anxiety, not valuable, physical limitations, frustrating, protection, burdened and socialization. The measurement value of the utility obtained the average value for each atrbut Utility is 40,51. The Pearson Chi-square (p < 0.05) looks that have the strongest correlation Socialization attribute with another attribute-attribute are: dizziness, happiness, independence, social events, respiratory disorder, chest pain, leg pain, sports/exercise limited, low self-esteem, anxiety, not valuable, physical limitations, frustrating, protection, burdened

Abstrak :
Background: Cardiac rehabilitation in patients with Coronary Artery Bypass Surgery (CABG) is an effective way in reducing mortality in patients with coronary heart disease (CHD). The presence of impaired cardiac autonomic function is increase the risk of arrhythmias and sudden death. Exercise training as one component of cardiac rehabilitation can improve autonomic function that can be measured indirectly with Heart Rate Recovery (HRR). The aim of this study is to assess the effect of the frequency of physical exercise on improved of HRR. Metod: The data used for this analysis include 100 patients who underwent second phase of cardiac rehabilitation after CABG at Pusat Jantung Nasional Harapan Kita, Jakarta between July and October 2013. Patients were categorized into group I (exercise 3 times a week) : 40 people and group II (5 times a week exercise) : 60 people. Heart rate recovery was measured with a 6 minute walk test (6MWT). Measurements were performed 2 times, in the early phase and the evaluation phase after 12 times. Increased HRR from both groups were analyzed by linear regression analysis. Result : In our study, age, gender, diabetes mellitus, psychological, smoking, coronary artery bypass surgery and the duration of aortic cross clamp did not affect the increase of HRR. Five times a week exercise training gives significant increase of HRR compare to 3 times a week exercise training after analyzed multivariate linear regression ( RR 2.9, 95% KI 1.53 to 4.40, p <0.001 ). Conclusion: Frequency of physical exercise 5 times a week give a better response to the increase in HRR than exercise 3 times a week.

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Latar Belakang: Rehabilitasi jantung pada pasien Bedah Pintas Arteri Koroner (BPAK) merupakan tindakan efektif dalam menurunkan mortalitas pada pasien dengan Penyakit Jantung Koroner (PJK). Adanya gangguan fungsi otonom jantung dikatakan meningkatkan risiko aritmia dan kematian mendadak. Latihan fisik sebagai salah satu komponen rehabilitasi jantung dapat meningkatkan fungsi otonom yang dapat diukur secara tidak langsung dengan Heart Rate Recovery (HRR). Penelitian ini bertujuan untuk menilai pengaruh frekuensi latihan fisik terhadap peningkatan HRR. Metode: Sebanyak 100 pasien pasca BPAK yang melakukan rehabilitasi jantung fase II dipilih secara konsekutif sejak 1 Juli ? 15 Oktober 2013 di Pusat Jantung nasional Harapan Kita, Jakarta. Pasien dikelompokkan menjadi kelompok I (3 kali latihan seminggu) sebanyak 40 orang dan kelompok II (5 kali latihan seminggu) sebanyak 60 orang. Heart rate recovery satu menit diukur dengan uji jalan 6 menit/6 minute walk test (6MWT). Pengukuran dilakukan 2 kali, pada fase awal dan fase evaluasi setelah 12 kali. Peningkatan HRR dari kedua kelompok dianalisa dengan analisa regresi linier. Hasil: Pada studi kami, usia, gender, diabetes melitus, psikologis, merokok, bedah pintas arteri koroner dan lamanya aortic cross clamp setelah dianalisa tidak mempengaruhi peningkatan HRR secara bermakna. Frekuensi latihan 5 kali seminggu memberikan peningkatan HRR yang bermakna secara statistik dibandingkan 3 kali seminggu setelah dianalisa dengan regresi linier multivariate (RR 2,9; 95 % IK 1,53-4,40, p<0,001) Kesimpulan: Frekuensi latihan fisik 5 kali seminggu memberikan respon yang lebih baik terhadap peningkatan HRR dibandingkan latihan 5 kali seminggu.

Abstrak :
ABSTRAK
Latar Belakang: Gagal jantung telah menjadi masalah kesehatan di seluruh dunia dan seringkali diasosiasikan dengan tingginya frekuensi perawatan di rumah sakit dan lama rawat yang panjang. Sayangnya, hingga saat ini belum ada satupun penelitian yang menggambarkan lama rawat serta profil pasien gagal jantung di Indonesia. Tujuan dari penelitian ini adalah mengetahui gambaran lama rawat dan mendeskripsikan karakteristik demografis serta karakteristik klinis dari pasien-pasien gagal jantung yang dirawat di RSUPN-CM pada tahun 2012

Metode: Dilakukan suatu studi dengan desain potong lintang dengan menggunakan data sekunder dari rekam medis pasien-pasien gagal jantung di RSUPN-CM selama tahun 2012. Selanjutnya dilakukan pengolahan data secara deskriptif untuk kemudian ditampilkan.

Hasil: Terkumpul data 331 pasien gagal jantung yang dirawat selama tahun 2012. Median usia adalah 58 tahun, 62,2% di antaranya adalah pria, dan 42,9% menggunakan jaminan sosial Askes/In-Health. Tingkat pendidikan yang terbanyak adalah pendidikan SMU dan sederajat sebanyak 23,9%. Median lama rawat 8 hari didapat dari perhitungan yang dilakukan terhadap semua pasien (NYHA I – IV), namun pada mereka yang dirawat dengan kelas fungsional NYHA III – IV saja, median lama rawatnya 9 hari. Pada awal perawatan, median tekanan darah sistolik 124 mmHg, denyut nadi 90 kali permenit, edema perifer terdapat pada 36,9% pasien, hipertensi 57,1%, diabetes mellitus 33,2%, penyakit jantung iskemik 74,9%, gangguan fungsi ginjal pada 46,2%, penyakit saluran pernafasan akut pada 45,9%, dan skor CCI terbanyak adalah 3.

Kesimpulan: Median lama rawat pasien gagal jantung di RSUPN-CM adalah 8 – 9 hari. Sebagian besar pasien adalah pria, berpendidikan SMU, dan menggunakan jaminan Askes/In-Health dengan median usia 58 tahun.

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ABSTRACT
Introduction: Heart failure has become global health issue worldwide, as it has been associated with high rate of readmissions and prolonged hospitalizations. Indonesia has never had any publication describing the profile and length of hospital stay of their heart failure patients. Hence, the aim of this study is to obtain the length of hospital stay and describe the demographic characteristic as well as clinical characteristic of heart failure patients in Cipto Mangunkusumo General Hospital hospitalized in the year of 2012.

Methods: A cross sectional study was designed using secondary data from heart failure patients’ medical records in Cipto Mangunkusumo General Hospital admitted during 2012. Furthermore, data were calculated and presented thereafter.

Results: Based on the medical records of the year 2012, 331 heart failure patients were included in the study. Median age was 58 years old, 62,2% were men, 42,9% used Askes/In-Health as their social insurance payor, and as many as 23,9% had graduated from senior high school level. Median length of stay was 8 days for all patients, while for patients admitted with NYHA functional class III – IV, the median length of stay was 9 days. When patients were admitted to hospital, median systolic blood pressure was 124 mmHg, pulse 90 beats per minute, peripheral edema was shown in 36,9% of patients, hypertension in 57,1%, diabetes mellitus in 33,2%, ischemic heart disease in 74,9%, renal impairment in 46,2%, acute respiratory conditions in 45,9% of patients, and the most frequent CCI score was 3.

Conclusions: Median length of stay for heart failure patients in Cipto Mangunkusumo GH is 8 – 9 days. Most patients were men, senior high school graduate, and used Askes/In-Health as their social insurance, with median age 58 years old.

Abstrak :
Tesis ini disusun untuk mengetahui pengaruh pemberian edukasi terhadap kepatuhan pasien penyakit jantung koroner dalam menjalani rehabilitasi jantung fase II di rumah. Penelitian ini menggunakan desain kuasi-eksperimental. Sebanyak 46 subjek penelitian pasien penyakit jantung koroner (pasca infark miokard atau pasien yang telah menjalani PCI maupun CABG) yang mampu berjalan mandiri dan dinyatakan mampu menjalani latihan di rumah, dibagi menjadi dua kelompok, yaitu kelompok perlakuan dan kelompok kontrol dengan masing-masing berjumlah 23 orang. Pada kelompok perlakuan diberikan edukasi mengenai rehabilitasi jantung fase II melalui penayangan video edukasi di rawat inap, pemberian pesan pengingat selama melakukan latihan di rumah, dan leaflet. Kelompok perlakuan melakukan latihan di rumah dengan frekuensi 3 kali/minggu selama 8 minggu. Kelompok kontrol hanya mendapatkan edukasi melalui leaflet saat di rawat inap, dan tetap disarankan untuk melakukan latihan di rumah dengan frekuensi yang sama dengan kelompok perlakuan. Pemantauan latihan dan kepatuhan dilakukan dengan logbook. Penelitian ini menunjukkan bahwa pemberian intervensi berupa edukasi memiliki pengaruh pada tingkat kepatuhan pasien penyakit jantung koroner dalam menjalani rehabilitasi jantung fase II di rumah, yang tergambar dari sesi latihan yang lebih tinggi pada kelompok intervensi (p=0.001). Angka kepatuhan (menjalani minimal 20 dari 24 sesi latihan) pada kelompok intervensi adalah sebesar 91%, sedangkan pada kelompok kontrol hanya 30%, dengan proporsi kepatuhan berbeda bermakna (p=0.001, RR 3,000 (1,597 – 5,636)). ......This thesis was aimed to know the impact of educational intervention to compliance of coronary artery disease patients in doing home-based cardiac rehabilitation phase II. The study design was quasi-experimental. A total of 46 coronary artery disease patients who were able to walk independently and suitable in doing home-based exercise were divided into 2 groups, each consisted of 23 subjects. Subjects in intervention group were given educational intervention through video, short-text reminder messaging while doing home exercise, and leaflet. They were stated to do home exercise for 3 times/week for 8 weeks. Subjects in control group only get educational leaflet, and stated to do the same home exercise regimen. Monitoring of exercise and adherence was done through logbook. This study showed that educational intervention could improve compliance in home-based exercise. The intervention group showed higher number 24(5-24) of exercise sessions (p=0.001). The compliance rate (defined as attending minimum 20 out of 24 sessions) in intervention group was 91%, while in control group 30%, with statistically significant difference.

Abstrak :
Penelitian ini bertujuan untuk mengetahui efektivitas latihan aerobik rehabilitasi jantung fase dua berbasis rumah dibandingkan berbasis rumah sakit pada pasien penyakit jantung koroner pascaintervensi koroner perkutan. Jumlah subjek penelitian sebesar 32 subjek, dengan masing-masing 15 subjek pada tiap kelompok yang dapat dianalisis. Subjek rata-rata berusia 57,97±11,59 tahun dan didominasi oleh laki-laki (80%). Kedua kelompok menunjukkan peningkatan bermakna uji jalan enam menit setelah 6 minggu intervensi dibandingkan sebelum (berbasis rumah sakit 397±78-450±73 m; berbasis rumah 350±106-454±67 m) nilai p<0,05. Peningkatan uji jalan enam menit tidak berbeda bermakna secara statistik pada kelompok berbasis rumah sakit (62 m) dibandingkan kelompok berbasis rumah (61 m) nilai p>0,05. Kesimpulan penelitian ini adalah latihan aerobik rehabilitasi jantung fase dua selama 6 minggu secara signifikan meningkatkan jarak tempuh uji jalan enam menit dan peningkatan tidak berbeda bermakna berbasis rumah sakit dibandingkan berbasis rumah pada pasien pasien penyakit jantung koroner pascaintervensi koroner perkutan. ......This study aims to determine the effectiveness of home-based phase II cardiac rehabilitation aerobic exercise compared to hospital-based in patients with coronary heart disease after percutaneous coronary intervention. Total subjects were 32 subjects, with 15 subjects in each group that could be analyzed. The average subject’s age was 57.97±11.59 years old and dominated by men (80%). Both groups showed a significant increase in the six-minute walk test after 6 weeks of intervention compared to baseline (hospital-based 397±78-450±73 m; home-based 350±106-454±67 m) with p value<0.05. The increase in the six-minute walk test was not statistically significantly different in the hospital-based group (62 m) compared to the home-based group (61 m) with p value>0.05. The conclusion of this study is Cardiac rehabilitation aerobic exercise in phase two for 6 weeks significantly increased the distance traveled on the six-minute walk test and the increase was not significantly different from hospital-based compared to home-based in patients with coronary heart disease after percutaneous coronary intervention.

Abstrak :
ABSTRAK
Stres oksidatif disebabkan ketidak seimbangan mekanisme pertahanan tubuh dengan radikal bebas. Radikal bebas dapat menginisiasi peroksidasi lipid yang berakibat kerusakan jaringan salah satunya pada jantung. Salah satu cara mengatasi hal ini dengan mengkonsumsi antioksidan eksogen dari makanan, yaitu bekatul. Bekatul mengandung tokoferol vitamin E . Oleh karena itu peneliti ingin mengetahui efek antioksidan bekatul varietas IPB3s dibandingkan vitamin E terhadap kadar malondialdehid MDA pada jantung tikus yang diinduksi karbon tetraklorida CCl4 . Penelitian ini menggunakan desain eksperimental dengan sampel 30 tikus jantan galur wistar. Sampel dibagi menjadi sepuluh kelompok dan masing-masing kelompok dilakukan pengukuran kadar MDA dengan metode Thiobarbituric Acid Reacting Substances TBARS . Hasil penelitian ini menunjukkan bahwa pemberian CCL4 tidak signifikan meningkatkan kadar MDA jantung dibandingkan kelompok kontrol. Pemberian bekatul IPB3s secara bermakna menurunkan kadar MDA jantung dibandingkan dengan pemberian CCl4. Tidak terdapat perbedaan kadar MDA bermakna antara pemberian bekatul dibandingkan dengan pemberian vitamin E. Berdasarkan hasil penelitian dapat disimpulkan bahwa bekatul dapat dijadikan sumber alternatif vitamin E.

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ABSTRACT
Oxidative stress is caused by the imbalance of the body s defense mechanism with free radicals. Free radicals can initiate lipid peroxidation resulting in cardiac tissue damage. One way to overcome this by consuming exogenous antioxidants from food, such rice bran. Rice bran contains tocopherol vitamin E . The aim of this study was to know the antioxidant effect of rice bran varieties IPB3s compared to vitamin E to the levels of malondialdehid MDA in the cardiac tissue of rats induced carbon tetrachloride CCl4 . This study used an experimental design with a sample of 30 male rats of wistar strain. The samples were divided into ten groups and each group performed the measurement of MDA levels measured using Thiobarbituric Acid Reacting Substances TBARS assay. The results of this study showed that the administration of CCL4 did not significantly increase cardiac MDA levels compared to the control group. It was also revealed the administration of rice bran varieties of IPB3s significantly decreased MDA level of cardiac tissue compared with CCl4 group. There was no significant difference in MDA levels between rice bran and vitamin E intake. Based on the research results can be concluded that rice bran can be used as an alternative source of vitamin E.

Abstrak :
Status fungsional yang rendah akan mempengaruhi kemampuan pasien gagal jantung dalam melakukan perawatan diri. Dukungan sosial menjadi salah satu faktor yang dianggap dapat mempengaruhi perilaku self care pada pasien gagal jantung. Penelitian ini bertujuan untuk mengetahui hubungan dukungan sosial dengan kemampuan self care pada pasien gagal jantung. Penelitian ini menggunakan desain cross sectional dengan teknik sampel consecutive sampling pada 33 responden di RS PGI Cikini. Hasil penelitian ini menunjukkan bahwa tidak ada hubungan yang bermakna antara dukungan sosial dengan self care pasien gagal jantung (p 0,33; α 0,05). Rekomendasi pada penelitian ini adalah perlunya peran perawat untuk mampu memfasilitasi pemberian dukungan sosial kepada pasien gagal jantung agar kemampuan self care dapat ditingkatkan.

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Deficient functional status will affect heart failure patients ability to perform self care. Social support is one factor can influence the self care behavior in heart failure patients. This research aimed to identify the relationship of social support and self care in heart failure patients. The research used cross sectional design with consecutive sampling technique to 33 respondents in RS PGI Cikini. The results showed that there was no significant relationship between social support and self care of heart failure patients (p 0.33; α 0.05). The research recommend the necessity of nurses to afford facilitating to give of social support to heart failure patients ability of self care can be improved.

Abstrak :
The textbook will describe the relationship between human cardiopulmonary system and exercise in a format that is related to the mode of exercise, health status and aging. It will include data regarding exercise training principles and the adaptations of the cardiopulmonary following, anaerobic, resistance and aerobic training. A more in-depth presentation of the cardiopulmonary system adaptations in pressing environments such as: warm, cold and altitude. Therefore, students will experience a depth and extent of content balanced with unique and effective learning features: It will help students find the way by both the text and subject matter. Knowing cardiopulmonary exercise function in health and disease will allow understand new research and findings relevant to cardiovascular status as assessed by cardiopulmonary exercise indices. It will bring together investigational exercise physiologists, cardiologists and scientists who share a wealth of experience needed to judge the cardiovascular status and function, and the impairments of patients with a variety of cardiac dysfunction. This book will provide a comprehensive, updated presentation of the information of the cardiovascular system as a whole, and its individual components.

Abstrak :
This Fifth Edition Resource, covers the entire scope of practice for cardiac rehabilitation and secondary prevention (CR/​SP) programs. This text was developed by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and parallels federal guidelines for cardiac rehabilitation programs. It contains information on promoting positive lifestyle behavior patterns, reducing risk factors for disease progression, and lessening the impact of cardiovascular disease on quality of life, morbidity, and mortality. The text has been updated and restructured, providing the most current models for designing and updating rehabilitation programs for patients and preventing second episodes. In addition to chapter revisions, there is new content on behavior modification, risk factors, and special populations. The chapter covering program administration has been completely rewritten to include new regulations and reimbursement standards as well as additional suggestions for new models for CR/​SP. The most recent Core Competencies for Cardiac Rehabilitation and Secondary Prevention Professionals and the Core Components of Cardiac Rehabilitation/​Secondary Prevention Programs have also been included in their entirety. There is strong evidence that participation in outpatient cardiac rehabilitation and secondary prevention programs decreases mortality and recurrent morbidity after a cardiac event. These guidelines offers procedures for providing patients with low-cost, high-quality programming, moving them toward personal responsibility for disease management and secondary prevention over a lifetime.