Phase III Cardiac Rehabilitation: Ambulatory Heart Groups　- A Model From Germany.

Approximately 7,000 ambulatory (outpatient) heart groups (AHG) with 125,000 patients who are physically active on a regular basis have been established in Germany since the mid-1960s. Following phase II cardiac rehabilitation (CR), patients in an AHG aim to meet their set CR goals in groups of up to 20 participants under the instruction of a competent exercise therapist, and with regular attendance by a physician. Physical activity is the dominant aspect; psychosocial and educative elements are integrated to stabilize secondary cardiovascular prevention. Patients are legally entitled by German rehabilitation law to participate in AHGs. According to current studies, only 13-40% of all patients attend an AHG after phase II CR. In 2019, special AHGs for patients with high cardiovascular risk (chronic heart failure) were established. In the future, special emphasis needs to be placed on the recruitment of more patients into AHGs, particularly for the known under-represented groups (i.e., women, older patients, patients with low socioeconomic status). Furthermore, AHGs have to be established for patients with special needs (e.g., adults with congenital heart diseases). To date, the efficiency of AHG participation has still not been sufficiently investigated. A case-control study analyzing the long-term results of AHG participation reported an improvement in physical performance, as well as a reduction in cardiovascular morbidity (54%) and medical costs (approximately 47%). More superior investigations in this field are needed.