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Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline January 18, 2022 Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038 e74 CLINICAL STATEMENTS AND GUIDELINES Synopsis Cardiac rehabilitation is an evidence-based intervention comprising patient education, behavior modification, and exercise training to improve secondary prevention outcomes in patients with CVD.8 Cardiac rehabilitation assists patients with adherence to healthy lifestyle habits; addresses comorbid conditions (eg, diabetes); monitors for safety issues, including new or recurrent symptoms; and facilitates adherence to evidence-based medical therapies.9 Cardiac rehabilitation may include a center-based cardiac rehabilitation program that incorporates face-to-face supervised exercise or an alternative cardiac rehabilitation delivery model that meets criteria for safety and effectiveness, as specified by the cardiac rehabilitation guidelines of the American Association of Cardiovascular and Pulmonary Rehabilitation.10 Recommendation-Specific Supportive Text 1. The safety and effectiveness of the traditional, medically supervised center-based cardiac rehabilitation model are well established. Observational studies and RCTs have demonstrated that center-based cardiac rehabilitation is effective in reducing hospital readmissions, secondary events, and deaths in patients with CVD.1,2,4,11 Guidelines and standards of care have been well defined for center-based cardiac rehabilitation, including core components,10 core competencies,12 clinical practice guidelines,13 performance measures,12 and certification (program and individual).9 Home-based cardiac rehabilitation can help improve delivery of cardiac rehabilitation to eligible patients by overcoming common barriers that impede a patient’s participation in center-based cardiac rehabilitation, including transportation challenges, competing time demands, and lack of a center-based cardiac rehabilitation program near the patient’s home.14 Core components of home-based cardiac rehabilitation are similar to those for centerbased cardiac rehabilitation.14 Cochrane reviews concluded that home- and center-based cardiac rehabilitation have similar effects on quality of life and costs among patients with recent MI or coronary revascularization.15-17 2. Patients and caregivers should receive a comprehensive plan of care and educational materials during the hospital stay that support adherence to evidence-based therapies. The “2019 ACC/ AHA Guideline on the Primary Prevention of Cardiovascular Disease”18 provides comprehensive recommendations for improving risk factors for CVD (unhealthy dietary pattern, lack of exercise and physical activity, obesity, diabetes, high blood cholesterol, hypertension, and tobacco use). This information and management can be accomplished in a center-based or a home-based cardiac rehabilitation program and should be tailored to age, health literacy, cultural practices, and socioeconomic status.7 The basic self-care activities important to CVD management are captured in the AHA’s Life’s Simple 7 program (eg, smoking cessation, maintenance of body mass index, physical activity, healthy diet, maintaining low cholesterol, maintaining normal blood pressure, and maintaining normal fasting plasma glucose).19 15.2 Smoking Cessation in Patients After Revascularization Recommendations for Smoking Cessation in Patients After Revascularization Referenced studies that support the recommendations are summarized in Online Data Supplement 50. COR LOE Recommendations 1 A 1. In patients who use tobacco and have undergone coronary revascularization, a combination of behavioral interventions plus pharmacotherapy is recommended to maximize cessation and reduce adverse cardiac events.1-3 1 A 2. In patients who use tobacco and have undergone coronary revascularization, smoking cessation interventions are recommended during hospitalization and should include supportive follow-up for at least 1 month after discharge to facilitate tobacco cessation and reduce morbidity and mortality.4-6 Synopsis Tobacco use, especially cigarette smoking, is a major risk factor for cardiovascular morbidity and mortality and is the leading preventable cause of death worldwide.6,7 Among patients with coronary heart disease, continued cigarette smoking after revascularization is associated with adverse clinical outcomes,8 particularly stent thrombosis.9 Electronic nicotine delivery systems or e-cigarettes10 are a class of tobacco product that emit aerosol containing fine and ultrafine particulates, nicotine, and toxic gases that may increase risk of CVD and pulmonary disease.11-13 The dominant pattern of e-cigarette use in adults is dual use of both combustible cigarettes and e-cigarettes.14,15 When patients are counseled about risk factor management after revascularization, the topic of tobacco abuse is paramount and timely, because patients who are hospitalized after revascularization are often at their most attentive state. The recommendations for smoking cessation counseling and treatment are outlined in the “2019 ACC/AHA Guideline on the Primary Prevention Downloaded from http://ahajournals.org by on October 7, 2026