Cardiac rehabilitation and risk factor management after myocardial infarction. Clinical and economic evaluation.

The increasing scarcity of available, and finite, health care resources, and the increased demands for health care, have made consideration of effectiveness and cost-effectiveness of health care services, such as the secondary prevention of heart disease, an imperative. There is considerable evidence that modification of cigarette smoking, hyperlipidemia, hypertension, and lack of physical activity, either singly or in combination, are effective in reducing the number of clinical events in the secondary prevention of heart disease. Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Data generated in economic evaluations of health care services, such as risk factor modification in the secondary prevention of heart disease, are useful in developing clinical practice guidelines and health policies. Smoking cessation is the most cost-effective intervention for patients with documented heart disease while treatment of hyperlipidemia and referral to cardiac rehabilitation are highly cost-effective per quality-adjusted life year and relatively cost-effective per year of life saved. Risk factor management, provided by a team including cardiovascular specialists and other physicians together with appropriately trained allied health professionals, is the cornerstone of optimal care in both the primary and secondary prevention of heart disease.