Relative role of ambulatory and residential rehabilitation.

Cardiac rehabilitation, derived from the concept of early mobilization after an acute cardiac event, seems destined to assume an important role in the approach to patients affected by chronic heart disease (ischaemic heart disease, valvular and congenital diseases, heart transplant, chronic heart failure, etc.). To respond to individual clinical needs, rehabilitative intervention should be organized either at an outpatient level or by combining outpatient and inpatient activities. Three different levels of intervention, of increasing complexity and specialization, are foreseen. First-level interventions are to be performed exclusively at outpatient level and directed mainly towards long-term care of stable chronic patients in order to keep them at the highest level of autosufficiency possible and to prevent acute events. Second-level interventions include the combination of outpatient and inpatient rehabilitative activity, based on an accurate prognostic stratification intended to reduce the consequences of the handicaps which the individual reports after an acute event. Third-level interventions include services provided in highly specialized centres; they should function at both inpatient and outpatient levels, and should be instituted in close collaboration with cardiosurgical departments that are particularly oriented towards transplant activity.