From hospital to smartphone: the future of cardiac rehabilitation

Abstract

Reijo Laaksonen, principal investigator of the European Union (EU)-funded CoroPrevention Project at Tampere University, speaks with calm conviction when discussing the future of secondary prevention in coronary heart disease. Throughout the interview, he emphasizes a single central message: secondary prevention saves lives, but current systems still fail to identify high-risk patients and provide personalized support at scale. As he explains, this is not a marginal concern. 'After a myocardial infarction, up to one in five patients will suffer another major event within a year 1 ,' he notes, pointing out that structured prevention remains underused despite its proven effectiveness. Two gaps in secondary prevention As the conversation turns to the roots of this problem, Laaksonen outlines the reality seen across European health systems. Despite remarkable progress in acute cardiovascular care, recurrent coronary events remain common. 2 Structured secondary prevention, including cardiac rehabilitation (CR), has repeatedly been shown to reduce morbidity and mortality, but it simply is not consistently delivered. Laaksonen points to the numbers: across Europe, only 30-50% of eligible patients attend centre-based CR programmes. 3 The reasons, he explains, are well known-lack of systematic referral, programmes that are insufficiently tailored to individual needs, logistical barriers such as travel distance and rigid scheduling, low health literacy, and lack of motivation. Even among those who do enter a programme, long-term follow-up is often undermined by fragmented communication between primary and secondary care, feeding into therapeutic inertia. 'The result is a persistent delivery gap,' he says. 'We know what works, but too few patients receive it'. But as Laaksonen stresses, there is a second gap that receives far less attention: risk stratification. Current European Society of Cardiology (ESC) guidelines do not provide a validated tool to identify which patients with established coronary heart disease (CHD) are at highest residual risk. Although tools such as U-Prevent exist, they are not embedded in clinical pathways. This leaves clinicians without a practical way to single out those who would benefit most from intensified, per-sonalized care. As the population of CHD survivors grows and health-care resources become increasingly stretched, this identification gap becomes more problematic. 'We simply cannot intensify preventive care for everyone,' he explains. 'We need to know who requires the most support'.