Cardiac Rehab Flashcards
What is cardiac rehabilitation?
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
What are the components of cardiac rehab?
- exercise training
- physical activity counseling
- tobacco cessation
- nutrition counseling
- weight/BP/Diabetes/Lipid management
- psychosocial and sexual counseling
- alcohol consumption counseling
What are the eligible diagnoses for cardiac rehab?
- 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 2 and class 3 patients w/o complex arrhythmias)
What are the contraindications for cardiac rehab?
- unstable angina
- uncompensated HF
- complex ventricular arrhythmias
- pulmonary arterial HTN greater than 60 mmhg
- severe or symptomatic aortic stenosis
- uncontrolled inflammatory or infectious pathologies
- any MSK condition that prohibits physical exercise
What are the benefits of cardiac rehab?
- risk reduction in mortality of 20% or higher, sustained up to 5yrs post
- reduced recurrent MI by 17%, 47% mortality benefit at 2 yrs
- significant reduction in all-cause and cardiovascular mortality and heart failure hospitalization
- decreased re-hospitalization
- increased rate of return to work from 38% to 53%
- reduced medical costs (even more so than medication possibly)
What are the risks of cardiac rehab?
overall, cardiac rehab is safe and well tolerated but there are very rare complications such as death, cardiac arrest, MI, or serious injury (~1 event in 60,000-80,000 pt. hours)
patients most at risk are those w. residual ischemia, complex ventricular arrhythmia and severe left ventricular dysfunction (EF less than 35%) especially NYHA 3 or 4
True or False: Almost all heart attack survivors participate in cardiac rehab
False, only 14-35% of heart attack survivors participate and only 31% pf pts after CABG particpate
What barriers are there that stop patients from participating in cardiac rehab?
- limited financial resources
- transportation difficulties
- lack of social or emotional support
- limited to no physician endorsement/support
- lower education level
- culture 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 rehab
How can PTs address some of the barriers to cardiac rehab?
- including referrals to CR/SPP in the hospital discharge plan
- automatically referring all eligible pts at the time of hospital discharge
- group classes
- use of telehealth
- patient selection of setting
What is included in phase 1 of cardiac rehab?
performed in hospital
goals-prevent skin breakdown, deconditioning, and DVT/VTE and direct gradual return to activity as well as early mobilization
careful monitoring of vitals, SxS of MI
recommended guidelines include intensity below 5 METS for 6-8 post-MI and keeping HR below 120 or no more than 20bpm from resting
What is included in phase 2 of cardiac rehab?
Outpatient setting
Take all baseline tests and assessments
12 weeks with 2-3 visits per week for 45min to an hour with or w/o ECg monitoring
reassessments every 2 weeks
formal reassessment at 6 weeks
What are the monitoring guidelines for cardiac rehab?
Hold exercise when:
- QRS widening over .12s
- over 6PVC per minute or couplet
- Glucose over 250 or below 60
- Systolic BP over 180 or below 90
- diastolic BP over 110
- Resting HR 100bpm or with afib over 110 bpm
True or False: the addition of stress reduction therapies to CR have demonstrated improved mortality benefits compared to CR alone
True
What is stage 3 of cardiac rehab?
Supervised maintenance
What is stage 4 of cardiac rehab?
Unsupervised Maintenance
