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Cognitive behavioral (CB) disease management programs were developed to help people with chronic back pain and have an extensive evidence base in that role. The same methods are now being adapted for use in other chronic illnesses. Using the example of angina, this chapter will explain how these techniques can be applied in cardiac rehabilitation (CR) and concludes with a brief description of such a program.

Heart foundations in Europe fulfill many roles in their work to prevent cardiovascular diseases. They fund a great deal of research, they provide information to the general public on healthy lifestyles, and they undertake educational programs in specific settings targeting selected audiences. An important role for many heart foundations is to lend support to cardiovascular patients and their families.

In the meta-analysis on cardiac rehabilitation (CR) after myocardial infarction published by Oldridge and coworkers, a reduction rate of 24% in all-cause death was found for CR as a whole. The rate was larger for programs with a duration of 36 or more months, where a 38% all-cause death reduction was found, higher than the reduction by programs below 12 weeks (8%) or between 12 and 52 weeks (24%). 52 weeks (24%).

In many industrialized countries, the percentage of the population that is elderly is rising;more people are surviving with conditions that in the past were fatal, and obesity and a sedentary lifestyle are still increasing.As a result, the number of people living with a chronic illness is also rising rapidly. For example, in the UK the proportion of people living with a chronic condition has risen from 21% in 1972 to 35% in 2002; 17% of those with a chronic condition have a cardiovascular illness or hypertension. Approximately 25% have three or more chronic health problems. The healthcare systems designed over the 20th century faced different challenges, initially to eradicate and then to control infectious disease and also to manage acute events. There was less attention given to prevention and rehabilitation, and services are not well suited to caring for a large number of people living, often for decades, with a high level of disability or complex disease management regimes.

Congenital malformations of the heart and vessels occur in 5–8 per 1000 live births, resulting in an incidence of approximately 0.7%., Some of these malformations (10–15%) do not require correction. Between 70% and 80% of defects can be corrected, and an increasing number of therapeutic procedures can be performed by interventional catheterization techniques, avoiding the need for open heart surgery. Definitive therapeutic procedures are increasingly carried out in early infancy, to avoid long-term complications resulting from the hemodynamic burden, or from chronic cyanosis. With improved techniques and experience, procedure-related mortality has been substantially lowered. In 2002, a total of 27,772 operations for the treatment of CHD were performed in Europe. Germany leads this statistic with 5868 operations for congenital heart defects in 2003; 4415 of those were performed using a heart-lung machine.

This is the story of a 37-year-old woman in her own words. She had no other cardiovascular risk factors than a history of smoking and being 3 months in the postpartum period.

The number of older people is growing rapidly worldwide. Today, more than 580 million people are older than 60 years and the number is projected to rise to 1000 million by 2020. The proportion of the population over 80 years, the so-called “old-old,” is increasing most rapidly. Life expectancy at all ages is also increasing. At 65 years, life expectancy ranges from 14.9 to 18.9 years and at 80 years from 6.9 to 9.1 years for men and women, respectively.With the increase in life expectancy, the leading causes of death have shifted dramatically from infectious diseases to non-communicable diseases. Cardiovascular disease is the most frequent single cause of death in persons over 65 years of age, and most importantly it is responsible for considerable morbidity and a large burden of disease, particularly in the community.

Chronic conditions are now the leading reason why people seek medical care. The syndrome of heart failure (HF) is the final pathway for myriad diseases that affect the heart, and is a salient example of the challenge posed by chronic disease. Although the understanding of chronic HF pathophysiology has changed and therapeutic paradigms have been revolutionized, a considerable burden of disability and unrelieved symptoms remains in optimally treated patients, with corresponding low quality of life, and poor prognosis which is worse than for many forms of cancer. In addition, the existence of multiple medical co-morbid conditions, an aging population, potential interaction among multiple medications and psychological impact combine to aggravate the complexity of HF management. Thus, HF is a chronic, costly, and life-threatening disorder, and the need for adequate management strategies is clear.

Heart transplantation has been performed as definitive therapy for endstage heart failure since the early 1980s. According to the international registry the annual number of patients is probably well over 4000 worldwide. Any special rehabilitation program for this group will depend on sufficient local concentration of heart transplant recipients (HTRs). Since 60% of all patients are reported from centers with less than 30 patients per year, going without any formal rehabilitation is a reality for many. On the other hand, one can hardly imagine a group of patients that is so obviously in need of rehabilitation because of the multifaceted physical and mental problems to be encountered pre- and postoperatively.

Implantable devices were introduced as life-saving equipment for millions of people suffering from coronary heart disease. Nowadays, not only traditional antiarrhythmic pharmacological therapy has been shown to decrease sudden cardiac death, but also pacemakers and cardioverter defibrillators have proved their value in the treatment of life-threatening rhythm disorders. In heart failure, cardiac resynchronisation therapy (CRT) and assist devices have recently demonstrated their importance,but no published data regarding physical exercise or training are available yet. This chapter will mainly deal with physical exercise and rehabilitation in patients who have received an implantable cardioverter defibrillator. Cardiac rehabilitation in patients with assist devices or pacemakers will be discussed only briefly.