More than 110,000 people a year die of CHD in England alone (1). Studies show that there is a reduction of between 20% (2) and 25% (3) in cardiovascular overall mortality in myocardial infarction (MI) patients who attend a cardiac rehabilitation programme. Patients who attend such programmes have significantly fewer re-admissions to hospital and re-infarctions at one year (4), five years (5) and ten years (5) after the first MI.

The National Service Framework for CHD stipulates the importance of a systematic approach towards the identification and management of risk factors for all cardiac patients and proposes that a multi-disciplinary cardiac rehabilitation service should be offered to all cardiac patients admitted to hospital.

Cardiac rehabilitation is defined by the World Health Organisation as: 'the sum of activities required to influence favourably the underlying cause of disease, as well as to ensure the patients best possible physical, social and mental conditions so that they may, by their own efforts, preserve or resume when lost, as normal a place in the community as possible' (6).

Cardiac rehabilitation should not be separated as an isolated form of therapy but should compliment and enhance the wide range of interventions and treatments offered to patients with cardiac disease. Comprehensive cardiac rehabilitation programmes tend to provide a range of services to aid recovery and adaptation of patients and to support family members. Exercise and education are usually the main components, though coronary risk factor modification and attention to the psychological sequela of CHD, through relaxation and stress management techniques, are equally important (7).

Another important aspect of successful cardiac rehabilitation is the involvement of the patient's family and partner. Research has identified that partners and family members often experience more psychological distress that the patient, which may have an important influence on the patient's own anxiety and long term outcome (8), (9). Therefore, partners or a family member should be invited to attend designated sessions on the rehabilitation course in an attempt to alleviate anxieties and answer any questions they may have.

Cardiac rehabilitation is often described as 'a four phase programme'. This section aims to define the types of activities that take place within each of the four phases. The hospital based rehabilitation page 'phases 1, 2 and 3'. It should be noted that this is an example protocol, based on the cardiac rehabilitation programme based at the Whittington Hospital and that details will vary across the Trusts. The community based rehab page discusses the types of activities that should take place in 'phase 4' or a community based rehabilitation programme. There is also information on how to refer patients to the community-based programme and a timetable of the classes available.