[Ambulatory vs. inpatient rehabilitation after established myocardial infarct--contra ambulatory rehabilitation].

Outpatient cardiac rehabilitation, as compared to inpatient rehabilitation, has substantial disadvantages for several patient groups. These drawbacks may lead to insufficient results in long term secondary prevention and to inadequate quality of life in patients with chronic heart disease. As outpatients, they remain in life circumstances which were, at least in part, causative for their heart diseases. Especially in elderly patients, those with a complicated course of disease, those who find adjusting their life style to the chronic disease state a daunting task, and those who find coping with the fact of being chronically ill as surpassing their psychological skills will find only in an inpatient setting all the relevant support delivered by a team of experts complementing each other for the benefit of the patient. A flexible system for inpatient or/and subsequent outpatient cardiac rehabilitation should be adopted which can be tailored to the individual patient's needs. It remains to be seen whether outpatient cardiac rehabilitation will really lower costs in the long run. This can be expected at best for a small group of relatively young patients with reasonably good physical fitness and no major problems in coping behaviour. The majority of patients needing cardiac rehabilitation does not fall into this group.