Cardiac Rehab Flashcards
1
Q
Cardiac rehabilitation
A
a medically supervised program that helps improve the health and well-being of people who have cardiovascular disease and conditions. •Programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. •In most current guidelines of cardiovascular societies worldwide, cardiac rehabilitation is a class I recommendation
2
Q
Components of cardiac rehab
A
- Exercise training
- Physical activity counseling
- Tobacco cessation
- Nutritional counseling
- Weight management
- Lipid management
- Blood pressure management
- Diabetes management
- Psychosocial Counseling (Stress)
- Sexual counseling
- Alcohol Consumption Counseling
3
Q
Diagnoses eligible for cardiac rehab
A
- Acute myocardial infarction
- Stable angina
- Coronary artery bypass graft surgery
- Heart valve repair or replacement
- Percutaneous transluminal coronary angioplasty
- Heart transplantation or heart-lung transplantation
- HEART FAILURE!!!!!
- Stable class II and class III heart failure patients without complex arrhythmias
4
Q
Contraindications for cardiac rehab
A
•Unstable angina,
•Decompensated heart failure,
•Complex ventricular arrhythmias,
•Pulmonary arterial hypertension greater than 60 mmhg,
•Intracavitary thrombus,
•Recent thrombophlebitis with or without pulmonary embolism
,•Severe obstructive cardiomyopaties,
•Severe or symptomatic aortic stenosis,
•Uncontrolled inflammatory or infectious pathologies and
- Any musculo-skeletal condition that prohibits physical exercise
5
Q
Benefits of cardiac rehab
A
- Risk reduction in mortality of 20% or higher, sustained up to 5yrs post
- Reduced recurrent MI by 17%, 47% mortality benefit at 2 years
- HFrEF CR demonstrate significant reductions (15%) in all-cause and cardiovascular mortality and heart failure hospitalization.
- Decreased re-hospitalizations
- Increased rate of return to work from 38% to 53%
- 12-weeks participation in cardiac rehabilitation has demonstrated reduces medical costs by 739$ per patient - After only 21 months follow-up - Possibly more cost effective than medications!
- A study in Sweden showed that participation in cardiac rehabilitation resulted in an overall cost savings of $12,000 per patient
6
Q
Risks of Cardiac rehab
A
- Overall, cardiac rehabilitation is safe and well tolerated with a very low rate of major complications such as death, cardiac arrest, myocardial infarction or serious injuries.
- 1 event in 60,000-80,000 patient-hours of supervised exercise.
- Patients most at risk are those with residual ischemia, complex ventricular arrhythmia and severe left ventricular dysfunction (ejection fraction of less than 35%), especially NYHA III or IV
7
Q
Barriers to participation of cardiac rehab
A
- Limited Financial resources
- Transportation difficulties
- Lack of social or emotional support
- Limited to no physician endorsement/support
- Lower Education level
- Cultural beliefs and understanding of disease and treatment
- Program availability and characteristics
- Older individuals are less likely to be referred to and to participate in cardiac rehabilitation
8
Q
Ways to address barriers to Cardiac rehab
A
- Including referral to CR/SPP in the hospital discharge plan
- Automatically referring all eligible patients at the time of hospital discharge
- Group Classes (Social Group)
- Use of TeleHealth
- Patient selection of setting
9
Q
Home based cardiac rehab
A
- Can be implemented effectively and comparable to hospital based.
- May improve maintenance of improvements in functional capacity.
- Cost Benefit
10
Q
Phases of cardiac rehab
A
- Phase 1: In hospital - Goal in general at least 3-5METs
- Phase 2: 1-12 weeks - Goal is at least 8METs
- Phase 3: Supervised Maintenance
- Phase 4: Unsupervised Maintenance
11
Q
Phase 1
A
- In Acute hospital •Goals - Prevent skin breakdown, deconditioning and DVT/VTE, early mobilization - Direct gradual return to activity
- Careful monitoring of vitals, signs and symptoms of MI - Recurrent MI can be possible within 4-8 weeks post MI
- Recommend Guidelines - Intensity <5METs for 6-8 post-MI - HR <120bpm OR no more than +20bpm from resting
12
Q
Testing recommendations
A
- Before hospital; discharge for prognostic assessment, activity prescription, evaluation of medical therapy - Submaximal at about 4 to 6 days, (ie6MWT, Stair Climb Test etc)
- Early after discharge for prognostic assessment, activity prescription, evaluation of medical therapy, and cardiac rehabilitation especially if the pre-discharge exercise test was not done - (Symptom limited; about 14 to 21 days).*
- Late after discharge for prognostic assessment, activity prescription, evaluation of medical therapy, and cardiac rehabilitation if the early exercise test was submaximal - (Symptom limited; about 3 to 6 weeks).*
13
Q
Phase 2
A
- 12 weeks 2-3/week 45-60min
- With or Without ECG monitoring
- Reassessments and progressions at least every 2 weeks
- Formal reassessment at 6 weeks
14
Q
When to hold exercise
A
- QRS Widening >0.12s
- > 6 PVC per minute or Couplet
- Glucose >250 or below 60
- Resting 90mmHg > SBP >180mmHg or DBP >110mmHg
- Resting HR>100 or with Afib>110bpm
15
Q
Goal of aerobic training
A
- The intensity of exercise among patients with heart disease is recommended to be 60–80% of the maximum heart rate or 50-85% VO2 peak
- Consider 30-50% Target HR early on
- Goal is to eventually build patient up to 45 minutes of continuous exercise by 3-6 weeks
- Some patients will take longer
- Progress gradually, increasing duration first to at least 20 minutes (5min week)
- Consider different modes
- Consider increasing Intensity 1 MET every 2 weeks
