Cardiac rehabilitation is a complex intervention that seeks to improve the functional capacity, wellbeing and health-related quality of life of patients with heart disease. A substantive evidence base supports cardiac rehabilitation as a clinically effective and cost-effective intervention for patients with acute coronary syndrome or heart failure with reduced ejection fraction and after coronary revascularization. In this Review, we discuss the major contemporary challenges that face cardiac rehabilitation. Despite the strong recommendation in current clinical guidelines for the referral of these patient groups, global access to cardiac rehabilitation remains poor. The COVID-19 pandemic has contributed to a further reduction in access to cardiac rehabilitation. An increasing body of evidence supports home-based and technology-based models of cardiac rehabilitation as alternatives or adjuncts to traditional centre-based programmes, especially in low-income and middle-income countries, in which cardiac rehabilitation services are scarce, and scalable and affordable models are much needed. Future approaches to the delivery of cardiac rehabilitation need to align with the growing multimorbidity of an ageing population and cater to the needs of the increasing numbers of patients with cardiac disease who present with two or more chronic diseases. Future research priorities include strengthening the evidence base for cardiac rehabilitation in other indications, including heart failure with preserved ejection fraction, atrial fibrillation and congenital heart disease and after valve surgery or heart transplantation, and evaluation of the implementation of sustainable and affordable models of delivery that can improve access to cardiac rehabilitation in all income settings.

心脏康复是一项复杂的干预措施，旨在改善心脏病患者的功能能力、幸福感和与健康相关的生活质量。大量证据支持心脏康复作为急性冠状动脉综合征或射血分数降低的心力衰竭和冠状动脉血运重建后患者的临床有效且具有成本效益的干预措施。在这篇综述中，我们讨论了心脏康复面临的当代主要挑战。尽管目前的临床指南强烈建议转诊这些患者群体，但全球心脏康复的可及性仍然很差。COVID-19 大流行导致心脏康复机会进一步减少。越来越多的证据支持以家庭为基础和以技术为基础的心脏康复模式作为传统以中心为基础的计划的替代或辅助，特别是在心脏康复服务稀缺、可扩展和可扩展的低收入和中等收入国家。非常需要负担得起的模型。未来提供心脏康复的方法需要与老龄化人口日益增长的多病症保持一致，并满足越来越多患有两种或多种慢性疾病的心脏病患者的需求。未来的研究重点包括加强其他适应症心脏康复的证据基础，包括射血分数保留的心力衰竭，