Who this is for
Adults 18+ with elevated cardiovascular risk who do NOT have an active acute coronary syndrome (unstable angina, active MI, decompensated heart failure). Those members are stabilized clinically before joining. AHA risk stratification (low / moderate / high) tunes touchpoint intensity, not eligibility.
What brings people here
Biometric screening with elevated inflammatory markers (hs-CRP), abnormal lipid panel, or BP >=130/80; self-reported family history of premature CVD; member request following a primary care recommendation; or Functional Medicine Assessment Cardiometabolic domain in elevated range.
Clinical framework
American Heart Association - Center for Health Technology & Innovation.
How the 8 weeks run
Baseline assessments, your first SMART goal, and the 1:1 that sets up everything after it.
Specialists and clinicians rotate in, and sessions come thickest here. One change at a time, in the domains your baseline flagged.
Re-score, refresh the care plan, and check in 1:1 on what is and is not working.
The remaining domains, at a lighter cadence, and the work of making the early weeks hold under pressure.
Final re-score, relapse prevention, and the plan for what happens next.
When your sessions fall
The program is built in four-week modules. Sessions come thickest at the start, when what you decide matters most, and step down as things settle. That is 5 sessions of 45 minutes across 8 weeks, counting the visit before week 1.
| Module | Weeks | Sessions | Cadence |
|---|---|---|---|
| Module 1 | Weeks 1 to 4 | 2 | every other week |
| Module 2 | Weeks 5 to 8 | 2 | every other week |
Week by week
- Before you beginBefore you begin
Your baseline across the eight cardiovascular health factors, your medication list, and a week of activity as it actually is. Bring your most recent numbers if you have them, and the fact that you do not if you do not.
- Week 1Cardiac rehabilitation
The single best-evidenced intervention available to you, and the one most often skipped. What it is, what the trials show, and how to find out whether you have been referred.
- Week 2Movement, safely
How much, how hard, and what the warning signs are. Your physical therapist builds a progression that accounts for your heart and your medications, because a beta blocker makes target heart rate a poor guide to effort.
- Week 3Eating for a heart
The dietary pattern that changed events rather than only cholesterol numbers, plus sodium and potassium. Where sodium actually comes from, which is mostly not the salt shaker.
- Week 4Mid-program: the eight factors again
Re-score the eight factors from week 0 and compare. Then the question nobody asks directly: are you actually taking every medication, every day, as prescribed?
- Week 5Sleep, and why it was added
Sleep joined the eight factors in 2022 on the evidence. What short sleep does, and the one thing worth escalating: sleep apnea is common after a cardiac event and treating it changes the other seven factors.
- Week 6Stress, mood and the heart
What the evidence supports and what is overstated. Depression after a cardiac event is common and associated with worse outcomes, and it is treatable.
- Week 7Your numbers and your medications
The list to take to your next appointment: your personal blood pressure target, your LDL target, kidney function, and anything you have quietly stopped taking.
- Week 8Making it hold
Score the eight factors one last time and put all three points side by side. Then the plan for week 9: who you contact, at what point, and what your maintenance week actually looks like.
Who you will work with
Your Whole Health Coach takes your first visit and closes every module, so it is the same person from the first session to the last. The specialists and clinicians below lead the weeks where their work is the focus.
Cindy is a Whole Health Coach with a background in clinical nursing and more than a decade of experience in healthcare. Her experience working closely with patients and multidisciplinary teams has given her a deep understanding of the many factors that contribute to overall health and well-being. Cindy believes that health is about more than any one diagnosis, symptom, or lab result.
Tonia is a Doctor of Physical Therapy, Integrative Nutrition Health Coach, and Certified McKenzie Spine Specialist with over 25 years of experience helping clients heal from pain, injury, and chronic conditions. She specializes in spine care, orthopedic rehabilitation, and restoring strength and vitality through personalized, science-based treatment.
Meet Lucy Paulise, who is a career and stress management coach, book writer, and Forbes contributor. Her passion lies in helping people discover and reach their full potential. She specializes in coaching individuals on how to manage stress, anxiety, imposter syndrome, perfectionism, or any other challenges they may face in their work or personal lives that can lead to feeling overwhelmed.
What we work on
| Domain | What this pathway does |
|---|---|
| Nutrition & Metabolism | DASH or Mediterranean pattern. Saturated fat <7% of calories, sodium <2g/day, soluble fiber 10-25g, alcohol <1 drink/day women, <2 men. Plant-forward where possible. |
| Movement & Mobility | 150 min/wk moderate aerobic + 2x/wk resistance training. Zone-2 cardio prioritized. Cap intensity until stress-test cleared if high-risk. |
| Sleep & Recovery | 7-9 hr/night, consistent wake time. STOP-BANG >=5 + ESS >=10 triggers same-day RN Navigator referral for polysomnography. |
| Stress & Resilience | PSS-10 down >=4 pts. Daily relaxation practice (breathwork, walks, journaling) 4+ days/week. |
| Mind & Mood | PHQ-9 baseline; q4 weeks. Depression doubles cardiac mortality risk - never optional in this pathway. |
| Preventive care | Annual physical, lipid panel, A1c, BP record. CT calcium scoring if intermediate risk. |
How progress is measured
These are the validated tools this pathway uses: at your first visit, at the mid-program review, and at the end.
| Tool | Cadence | Owned by |
|---|---|---|
| AHA Life's Essential 8 | Baseline, Wk 4, Wk 8 | WHC |
| Home BP series (7-day avg) | Daily in Build phase; biweekly maintenance | WHC + member |
| Lipid panel | Baseline, then about 12 weeks after starting therapy and quarterly thereafter, with the member's own clinician after the program | RN Nav coordinates |
| STOP-BANG + ESS | Onboard; PRN | Sleep specialist |
| PHQ-9 + GAD-7 | Onboard, q4 weeks | WHC; LCSW reads |
| Med-Diet Adherence Screener | Onboard, q4 weeks | Nutrition clinician |
| PAR-Q+ | Before any exercise prescription | Exercise clinician |
The research behind this pathway
Your clinician playbook was built from the guidelines and studies below. They are listed so you can read them yourself: every one is a real, published paper and the number at the end of each line is its PubMed ID.
Guidelines this pathway follows
- Life's Essential 8 · American Heart Association
The eight measures of cardiovascular health scored at baseline, mid-program and exit. PMID 35766027
- 2025 AHA/ACC High Blood Pressure Guideline · American Heart Association and American College of Cardiology
Blood pressure targets and the home-monitoring routine. PMID 40811516
- Depression as a risk factor after acute coronary syndrome · American Heart Association
Why mood screening is a standing part of a cardiac pathway rather than an add-on. PMID 24566200
Key studies
- Lloyd-Jones DM et al. (2022). CirculationLife's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association
Defines Life's Essential 8, the eight measures of cardiovascular health this pathway scores you on at baseline, mid-program and exit. PMID 35766027
- Estruch R et al. (2018). N Engl J MedPrimary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts
7,447 people at high cardiovascular risk, randomized to a Mediterranean diet or a low-fat control. The Mediterranean groups had about 30 percent fewer major cardiovascular events. PMID 29897866
- Dibben G et al. (2021). Cochrane Database Syst RevExercise-based cardiac rehabilitation for coronary heart disease
Cochrane's review of exercise-based cardiac rehabilitation. It cut heart attacks, produced a large reduction in all-cause hospital admission, and improved quality of life out to 12 months. PMID 34741536
- Lichtman JH et al. (2014). CirculationDepression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association
The American Heart Association's statement that depression after a heart event predicts worse outcomes. It is why mood screening is not optional on this pathway. PMID 24566200
- SPRINT Research Group (2015). N Engl J MedA Randomized Trial of Intensive versus Standard Blood-Pressure Control
9,361 people randomized to a systolic target under 120 rather than under 140. The tighter target cut cardiovascular events and deaths. PMID 26551272
- Cholesterol Treatment Trialists' Collaboration (2010). LancetEfficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials
170,000 people across 26 trials. Every further 1 mmol/L drop in LDL cholesterol cut major vascular events by about a fifth, with no threshold below which it stopped helping. PMID 21067804