(Vienna, 09 September 2026) The European Society of Cardiology (ESC) has published its first standalone guideline on cardiac rehabilitation. Jolanta Siller-Matula from the Medical University of Vienna was involved in developing the new European recommendations as a member of the international ESC Task Force and a representative of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). The recommendations define cardiac rehabilitation as an integral part of long-term cardiovascular care – ranging from exercise and optimisation of drug therapy through to nutrition, mental and sexual health, and digital rehabilitation programmes. For the first time, particular emphasis is placed on individualised and gender-sensitive medicine.
“Cardiac rehabilitation should not be seen as an isolated exercise programme following a cardiac event. It is a crucial phase of cardiovascular secondary prevention, aimed at improving physical fitness, managing risk factors, optimising drug therapies and supporting patients in regaining a sense of security and quality of life in the long term,” says Jolanta Siller-Matula.
A broader approach to rehabilitation
The new guideline significantly broadens the scope of cardiac rehabilitation. It is aimed at patients who have suffered an acute coronary syndrome or who have coronary heart disease, as well as those with heart failure, valvular heart disease, atrial fibrillation, cardiomyopathies, congenital heart defects or who have undergone heart surgery.
Rehabilitation is understood not merely as aftercare and exercise, but as part of long-term cardiovascular secondary prevention. In addition to physical exercise, this includes diet, smoking cessation, patient education and self-management, as well as mental and sexual health and the return to everyday life and work.
A key principle of the new guidelines is personalised rehabilitation. The process begins with a comprehensive assessment of heart disease, physical fitness, comorbidities and risk factors, as well as diet, mental health, lifestyle and social circumstances. Individual rehabilitation goals are then set on this basis.
A particular focus on gender-sensitive care
Another key focus is on existing inequalities in care. Although cardiac rehabilitation is effective for both sexes, women are referred less frequently and are less likely to take part in programmes. The guidelines suggest possible measures including automated referral systems, flexible appointment times, childcare, tele-rehabilitation and home-based services, as well as programmes specifically tailored to women.
Risk factors that are particularly relevant to women should also be identified more systematically. These include, amongst others, gestational diabetes, hypertensive disorders of pregnancy, premature menopause, polycystic ovary syndrome and endometriosis.
Treatment optimisation and digital services
Rehabilitation should also be used to review and optimise drug therapy, monitor treatment goals and promote long-term adherence. Psychological distress such as depression and anxiety, as well as sexual dysfunction, should be systematically assessed and treated where necessary.
At the same time, home-based rehabilitation, tele-rehabilitation and hybrid models are gaining in importance. Face-to-face and digital services can be combined according to clinical risk and patients’ needs. Telemonitoring, smartphone applications and wearables can track physical activity and physiological parameters and support the continuous adjustment of treatment.
The 2026 ESC Guidelines on Cardiac Rehabilitation thus represent the first comprehensive European framework of guidelines for cardiac rehabilitation, with the overarching aim of achieving more personalised and equitable cardiovascular care. The guidelines were published in the European Heart Journal.
Publication: European Heart Journal
2026 ESC Guidelines on cardiac rehabilitation: Developed by the task force on cardiac rehabilitation of the European Society of Cardiology (ESC)
Endorsed by the European Society of Physical and Rehabilitation Medicine (ESPRM) and World Organization of Family Doctors (WONCA)
https://doi.org/10.1093/eurheartj/ehag099
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag099/8766284