Cardiac rehabilitation: from Hellerstein to the millennium.

In the 1950s, Herman Hellerstein set out his ideas for the comprehensive rehabilitation of patients recovering from acute cardiac events, using a multidisciplinary team. His approach has been adopted by most developed countries, with varying speeds and enthusiasm. His original ideas have hardly been improved on. However, changes in the demographics and epidemiology of heart disease have led to changes in the patient groups included in cardiac rehabilitation today and, despite falling death rates from coronary disease, the numbers who might benefit from this treatment have grown steadily. Unfortunately, only a minority of patients with heart disease who would benefit are offered rehabilitation. The provision of cardiac rehabilitation in most countries is seriously deficient, and suggestions are made for improving this situation to fulfil Hellerstein's vision.