心脏康复目标人群
　　美国心脏康复患者包括六类: 稳定性心绞痛患者、心肌梗死后患者、冠状动脉旁路移植术（CABG）后患者、支架置入术后患者、心瓣膜置换/修补术后患者和心脏移植患者。目前，老年医疗保险将覆盖这六类患者。尽管众多心力衰竭患者从心脏康复中获益极大，但目前他们的心脏康复治疗并未纳入医疗保险范围。因此，美国心肺康复协会正努力与政府协商，将心力衰竭患者心脏康复治疗纳入医疗保险范围。
　　心脏康复的心理疗法
　　2008年通过了心肺康复法案，2010年开始实施。在该法案中的密集型心脏康复项目特别关注冠状动脉疾病的心理部分。虽然运动训练是组成心脏康复的基础，并且在心脏康复过程中发挥了相当重要的作用，需要关注，但是人们也需要进行社会心理疏导。例如瑜伽和冥想。我们用临床社会工作者组成的团体来提供支持。接待人们因为沮丧和孤独进行的咨询，因为这些思想问题已经对他们的身体、心脏和血管系统产生了实质性影响。人们在压力过大时会释放大量的儿茶酚胺导致血压升高。心理疏导让人们通过减压而得到放松。与人分享他们的感受和情绪还可以减轻与冠状动脉疾病合并的抑郁症。
　　影响心脏康复结果的主要因素
　　研究显示，人体增加一个MET (即身体静息状态下的代谢当量或氧气量)， 死亡率可降低13%~15%。如果人们完成心脏康复，通常可以增加20%~30%的氧容量，这是死亡率降低25%的原因。据最新统计结果显示，在CABG和药物治疗基础上，如果患者完成整个阶段的心脏康复训练，死亡率下降50%左右。如果人们参加体育锻炼，减轻压力以及合理饮食，将可能避免心血管死亡。
　　心脏康复治疗的推广
　　我通常利用院内心脏科会诊和医疗会诊机会，向心脏科医生展示心脏康复治疗的循证医学证据，让他们认识心脏康复治疗及其带来的益处。医学院校存在的问题是未让医学生接触心脏康复治疗方面的教育。我认为这是一个教育的过程。在多篇重要论文中，心脏康复已被列为IA类推荐。是否进行心脏康复治疗是衡量每一位医生在治疗心脏患者时都需要实施的工作指标。随着越来越多的医生更多了解心脏康复，并学习心脏康复的知识，心脏疾病治疗效果正发生改变。
　　International Circulation: What are some of the target populations for cardiac rehabilitation and what kind of cardiac disease patients should be included in cardiac rehabilitation plans?
　　Dr. Murray Low: In the United States， we have six populations: those who have a diagnosis of stable angina，are status post-myocardial infarction， are status post-coronary bypass surgery，or stents， or valve replacement and repair， and， of course， heart transplant. Right now， medicare for senior citizens will cover those six diagnoses. My colleagues and I in the American Association of Coronary and Pulmonary Rehab are working hard with the government and Medicare to also include patients with heart failure. We see this as a huge population that could benefit immensely from cardiac rehab but is， right now， not a population where medicare will reimburse you for those services.
　　International Circulation: My next question is about psycho-therapy for cardiac rehab. You mentioned services like counseling， meditation， or physical activity may help. What are the roles of psychological support in cardiac rehab?
　　Dr. Low: The cardiac and pulmonary rehab act was passed in 2008 and implemented in 2010. Within that act there are two interesting programs called intensive cardiac rehabilitation. Those programs are the Dr. Dean Ornish Program for Reversing Heart Disease and the Nathan Pritikin Program. The Dr. Dean Ornish program especially focuses on the psychological component of coronary disease. We cannot just look at the exercise training， which forms the basis of cardiac rehab and is quite effective， but we also know that people need to deal with the psycho-social part.  For example， we offer yoga and meditation. We offer group support， which is led by a clinical social worker. People come to us as depressed and lonely， dealing with issues that， although cerebral issues， have physicals effects on their body， heart， and vascular system. People in high stress are going to release a lot of catecholamines， high blood pressue. Getting people to relax results in stress reduction. Sharing their feelings and emotions can reduce some of the depression that comes with coronary artery disease.
　　International Circulation: What are some of the primary factors which effect the outcomes of cardiac rehab?
　　Dr. Murray Low:  According to our most high-powered publications， if we can increase people’s physical work capacity—their cardiac fitness—we have data that shows for every one MET (metabolic equivalent，or the amount of oxygen our body uses at rest) increase we see anywhere from a 13%~15% reduction in mortality. We typically can increase aerobic capacity by 20%~30%， which is why meta analyses show reductions in morality of about 25%， if people complete cardiac rehab. The most current research we have shows a reduction in mortality of close to 50% for people who complete the 36-session program. That is on top of having CABG， taking medication， and this is added  to the benefit of attending cardiac rehab. If we can get people to do physical training， to do stress reduction， to modify their food， then I can say，with my 30-years experience，that they will probably die of something other than coronary disease. We all will succumb to something.
　　International Circulation: How do we get cardiologists to start applying or recommending cardiac rehab to their patients?
　　Dr. Murray Low: In my hospital， I do cardiology grand rounds and medical grand rounds to show them what they understand best: evidence-based medicine. Show the research and the power of the science behind it. Reeducate them. The problem with medical schools， and I teach some third year students from Columbia， is that they are never exposed to the efficacies of cardiac rehab. I think it is an education process. We have had important papers published in all the major journals indicating that cardiac rehab is a class IA recommendation. It is a performance measure that every doctor needs to practice when working with cardiac patients. I am seeing a real change as more physicians learn more and are educated about the science behind this. That life style change is as powerful as anything they prescribe and may indeed be more powerful.