The International Council for Cardiovascular Prevention and Rehabilitation (ICCPR) wishes to congratulate the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) on this practitioner‐focused textbook. Its main aim is to take its internationally recognised Standards and Core Components and show how they can be put ‘into practice’. In 1995 the UK (via the BACR) was one of only a handful of countries in the world to have produced a set of National Guidelines in the form of a textbook. Since then, the BACR (now the BACPR) have gone on to publish three editions of their Standards and Core Components (2007, 2012/2013, and 2017/2018). As BACPR was one of the three founding members of the ICCPR (along with Canada and the USA), its Standards and Core Components have always, and will continue to be, featured as an important reference in our website compilation of key cardiac rehabilitation resources (http://globalcardiacrehab.com/). These resources promulgate advocacy, value, and guidance for cardiac rehabilitation as an obligatory part of any modern or developing cardiovascular health service. One of the hallmarks of UK programmes and the BACPR's approach is delivering a large proportion of services in the community and in patients’ homes, which is a model the ICCPR promotes for developing countries. We have no doubt this textbook will become a valued resource for cardiac rehabilitation and cardiovascular disease prevention specialists around the world.

Alison Atrey
Consultant Specialist Dietitian
CVD Management
Toronto, Ontario, Canada

Nick Brace
Principal Clinical Psychologist
Department of Health Psychology
Swansea Bay University Health Board
Neath Port Talbot Hospital
Port Talbot, UK

Samantha Breen
Allied Health Professionals Manager
Manchester Royal Infirmary and St Mary’s Hospital
Manchester University NHS
Foundation Trust
Manchester, UK

BACPR Standards Writing Group
British Association for Cardiovascular Prevention and Rehabilitation
London, UK

John Buckley
Professor of Applied Exercise Science
Centre for Active Living
University Centre Shrewsbury
Shrewsbury, UK

Molly Byrne
Professor in Health Psychology
Director Health Behaviour Change Research Group
School of Psychology
National University of Ireland
Galway, Ireland

Kathryn Carver
Heart Failure Lead Nurse
Addenbrooke's Hospital
Cardiology Services
Cambridge, UK

Caroline Chessex
Associate Professor
Department of Medicine
University of Toronto
Fellowship Program Director
Division of Cardiology
University Health Network/Sinai Health System
Toronto, Ontario, Canada

Susan Connolly
Consultant Cardiologist and Clinical Lead
Our Hearts Our Minds Programme for Cardiovascular Health
Western Health and Social Care Trust
Enniskillen, Northern Ireland

Barbara Conway
Associate Lecturer
Department of Health Science
University of York
York, UK

Patrick Doherty
Chair in Cardiovascular Health
Director of the National Audit of Cardiac Rehabilitation (NACR)
Department of Health Sciences University of York
York, UK

Cate Ferry
Manager Clinical Programs NSW
National Heart Foundation of Australia
Sydney, Australia

Dorothy J. Frizelle
Consultant Clinical Health Psychologist & Head of Service
Executive Director for Member Networks ACP–UK
The Mid Yorkshire Hospitals NHS Trust
Department of Clinical Health Psychology
Dewsbury District Hospital
Dewsbury, UK

Gill Furze
Emeritus Professor in Health and Life Sciences
Faculty of Health and Life Sciences
Coventry University
Coventry, UK

Robyn Gallagher
Professor of Nursing
Faculty of Medicine and Health
The University of Sydney
Sydney, Australia

Sherry L. Grace
Chair, International Council of Cardiovascular Prevention and Rehabilitation;
Professor, York University;
Sr. Scientist & Director
Cardiac Rehabilitation Research
University Health Network
University of Toronto
Toronto, Ontario, Canada

Tim Grove
Lecturer in Physiotherapy
Department of Clinical Sciences
Brunel University
Uxbridge, UK

Alex Harrison
Research Fellow
Department of Health Sciences
University of York
York, UK

Sally Hinton
BACPR Executive Director
BACPR London, UK

Catriona Jennings
Cardiovascular Specialist Nurse
National Institute for Prevention and Cardiovascular Health
National University of Ireland
Galway, Ireland

Ann Marie Johnson
Year of Care Facilitator
Leeds Partnerships Clinical Commissioning
Leeds, UK

Jennifer Jones
Director of Preventive Medicine and Cardiovascular Health
National University of Ireland
Galway, Ireland;
Reader in Physiotherapy
Department of Clinical Sciences
Brunel University
Uxbridge, UK

Joe Mills
Consultant Cardiologist
Liverpool Heart & Chest
Hospital NHS Foundation Trust
Liverpool, UK

Nerina Onion
NACR Programme Manager
Department of Health Sciences
University of York
York, UK

Corinna Petre
NACR Project Manager
Department of Health Sciences
University of York
York, UK

Marie‐Kristelle Ross
Cardiologist
Hotel‐Dieu de Lévis, Universite Laval
Quebec City, Quebec, Canada

Gail Sheppard
Senior Lecturer/Academic Group Lead
Public Health and Health Promotion
Canterbury Christ Church University
Canterbury, UK

Linda Speck
Consultant Clinical Health Psychologist and Visiting Professor
Health Psychology Service
Cwm Taf Morgannwg University Health Board
Princess of Wales Hospital, Bridgend, and University of South Wales, UK

Sally Turner
Physiotherapist Health
Programme Manager
Basingstoke & Alton Cardiac
Rehabilitation Charity Ltd
Alton, UK

Rachel Vine
Community Dietetic Team Manager
Leeds Community Healthcare NHS Trust, Parkside Community
Health Centre
Leeds, UK

Vicki Wade
Senior Cultural Advisor
Rheumatic Heart Disease
Australia Menzies School of Health Research
Casuarina, Australia

Robert West
Professor of Health Psychology
Department of Behavioural Science and Health
Institute of Epidemiology and Healthcare
University College London
London, UK

CARDIOVASCULAR PREVENTION AND REHABILITATION IN PRACTICE

This comprehensive book covers all the aspects of prevention and rehabilitation that are important to those who help cardiac patients to return to normal health – and also guide them to reduce to a minimum the risks of recurrence. The scope of the problem is described, followed by the nature and standards of cardiac rehabilitation (CR) and how behaviour can be changed to ensure the adoption of a healthier lifestyle. The roles of the professionals involved in treating patients leads to the need for patients to know how best to work for their own recovery.

The British Association for Cardiac Rehabilitation (BACR) was set up in 1992 and the first guidelines were published in 1995. Since then much has been achieved. In 1992 less than half of all hospitals treating heart patients had active CR programmes; today the figure is 100%. In 2000 the UK Department of Health (DoH) published the National Framework for CHD and included CR as Standard 12, ushering in the general acceptance of CR as a vital part of the management of cardiac patients. In 2010 the BACR adopted its new name, British Association for Cardiac Prevention and Rehabilitation (BACPR), to recognise its role in cardiovascular prevention together with rehabilitation. The BACPR then set out the standards and core components for cardiovascular prevention and rehabilitation in the UK. Now all centres are requested to report their performance to the National Audit of Cardiac Rehabilitation (NACR) annually using patient level data. The NACR annual report details national performance and how it is improving.

The scientific evidence base for prevention and rehabilitation is compelling – the challenge is effective implementation in everyday clinical practice. Although much has been achieved there is still much to do, both in the UK and globally, to appropriately fund service provision to levels and standards used in the underpinning research trials. In 2013 the DoH produced a Cardiovascular Disease Outcomes Strategy, which has provided guidance on the recommended percentage uptake of CR in eligible patients. Encouragingly, in the UK, uptake of CR has grown to world leading levels, but this is still only at 50%. Not only is this figure well below the recommended uptake level, there remain inequities and poor representation for women and ethnic minorities. Patients following heart surgery or an acute coronary syndrome are more likely to be included than those with exertional angina. Other presentations of atherosclerotic disease such as stroke and peripheral arterial disease are rarely included. Only a few heart failure patients receive exercise rehabilitation. Again, whilst there are improvements in the percentage of recruited patients being assessed both before and after the programme these are still not at recommended levels, and longer term outcomes are not usually measured at all.

The BACPR is working hard to improve this national picture by setting out the Standards and Core Components described in this book. These have been used to create a certification process for which all centres are invited to apply. The standards for qualifying for this certification have been set relatively low to encourage as many centres as possible to apply but so far only a minority have done so. Over time the number of centres attaining those standards, and exceeding them, should rise with the ambition of reaching 100%.

This book describes what is needed to bring the level of prevention and rehabilitation received by cardiac patients up to acceptable levels. It makes interesting and educational reading. You have got this far – now read on!