Cardiac Rehabilitate

Question 1

Burden of CV disease

Answer 1

• 124,000 heart attacks every year in U.K. (BHF, 2011)
• CVD cost UK economy 30bn/year
• key = secondary prevention
• role of cardiac rehabilitation

Question 2

Components of Cardiac rehabilitation

Answer 2

• disease awareness and management
• nutrition education
• exercise
• smoking cessation
• diabetes management
• relaxation/stress management
• medication info
• counselling

Question 3

Who needs cardiac rehab?

Answer 3

• MI
• Angioplasty or CABG
• Heart valve repair or replacement
• A heart transplant or a lung transplant
• Stable angina
• Heart failure

Question 4

Survival benefit of CR?

Answer 4

• ⬇️ all-cause mortality 27%

- ⬇️ cardiac mortality 31%

Question 5

Define cardiac rehabilitation

Answer 5

A coordinated, multifaceted intervention designed to optimise a cardiac patient’s physical, psychological, and social functioning, in addition to stabilising, slowing or even reversing the progression of the underlying atherosclerotic processes thereby reducing morbidity and mortality (Leon et al., 2005)

Question 6

What are the 4 phases of cardiac rehabilitation?

Answer 6

• Phase 1 - in hospital, assessment, treatment, surgery
• Phase 2 - at home
• Phase 3 - outpatient hospital/accredited fitness facility
• Phase 4 - community based

Question 7

What is the duration and cardiac rehabilitation in phase 1?

Answer 7

• Duration - 3-10 days

* CR - education, mobilisation, literature, heart manual

Question 8

What is the duration and cardiac rehabilitation in phase 2?

Answer 8

• Duration - 4-6 weeks

* CR - walking, risk factor modification, contact: ph/home visit

Question 9

What is the duration and cardiac rehabilitation in phase 3?

Answer 9

• Medically supervised
• Duration - 6-12 weeks
• CR - education, risk factor modification, exercise classes

Question 10

What is the duration and cardiac rehabilitation in phase 4?

Answer 10

• Duration - indefinitely

* CR - exercise classes, LT maintenance of risk factor modification

Question 11

Screening in CR

Answer 11

•Aim: risk stratification 
•Attempt to predict those at risk of exercise related cardiac incidents and to tailor exercise prescription, supervision + monitoring appropriately to the individual 
- unstable ischemia 
- uncontrolled arrhythmias 
- severe pulmonary HT

Question 12

Assessment in CR

Answer 12

• functional capacity (CPET)
• ischemic burden (CPET)
• arrhythmic potential (CPET)
• hemodynamic potential (CPET)
• medical records: current and past history, symptoms
• subjective interview: risk factors