Refractory Angina Referral to Cardiovascular Rehabilitation: A Neglected Patient

Cardiovascular rehabilitation (CR) is an effective and safe treatment for stable coronary artery disease (CAD) patients, with established benefits to improving quality of life and reducing cardiovascular mortality and hospital admission. The effects of CR on reducing myocardial ischemia have been documented,^– justifying the CR Class IA recommendation. However, CR is still neglected and underused worldwide.

Refractory angina (RA) is a disabling condition affecting CAD patients under optimized medical therapy with a residual ischemic burden for more than three months who are ineligible for revascularization interventions. RA is associated with reduced quality of life, exercise limitation, and biopsychosocial disorders. Ideally, clinical management should be guided by specialized centers aiming to optimize multiple pharmacologic therapies and evaluated interventional options. In this context, comprehensive CR is a valuable treatment for RA considering its multi-component approach, including risk factor management, psychological support, and exercise training, although the latter possess limited evidence.

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