Cardiac Rehabilitation Flashcards
Cardiac Rehabilitation definition
- sum of activities required to influence
favourably the UNDERLYING CAUSE OF CVD, as well as to provide the best conditions so that the patient by their own efforts, PRESERVE OR RESUME OPTIMAL FUNCTIONING in their community and through improved health behaviour, SLOW OR REVERSE PROGRESSION OF DISEASE
Who can go to cardiac rehabilitation (5)?
- valve/other surgery
- cardiac transplants
- GUCH patients
- complex devices
- POST MI/CABG/PCI, stable CAD, chronic
heart failure
Goals of Cardiac Rehabilitation:
- reduce the risk of adverse cardiac events:
death, MI, rehospitalisation - improve cardiac symptoms
- curtail physiological and psychosocial
effects of heart disease - reintegrate patients to the community with
good functional status
Benefits of cardiac rehabilitation (8):
- reduced mortality
- reduced adverse cardiac events (MI)
- reduced re-hospitalisations
- higher smoking cessation rates
- improved functional status
- weight reduction
- lower BP and lipids
- better diabetic control
Cardiac rehabilitation evidence is ——- data
- observational
- rehabilitation is associated with better
health outcomes
Impact of cardiac rehab on lipids as a risk factor
- improved compliance with meds (statins)
Impact of cardiac rehab on hypertension as a risk factor
improved compliance with meds (ACE inhibitors Ramipril0
Impact of cardiac rehab on diabetes as a risk factor
- improved compliance with healthy diet
- improved compliance with meds
(metformin,insulin)
Six core components of cardiac rehab (BACPR):
- health behaviour change & EDUCATION
- lifestyle risk factor management
- psychosocial health
- medical risk management
- long term strategies
- audit and evaluation
Phase 1 cardiac rehab
- in hospital, pre-discharge: clinical
assessment, education, reassurance, risk
factors acknowledged - typically during first week
- mobilisation started
- individualised exxercise programme
Phase 2 cardiac rehab
- at home
- week 2-6:
- personal exercise programme
- stress management
- reinforcement health ed - 5-30 mins of daily exercise at home, sitting
to standing, stretching, walking - telephone contact with rehab team + home
visit if required
Phase 3 cardiac rehab:
- community setting
- week 6b onwards for 6 months
- exercise programme: assessent, structured
- health education programme: 6 week
rolling programme - provides psychosocial support
Phase 4 cardiac rehab:
- life long maintenance
- unsupervised exercise:
- at lest 2.5 hours a week
- bouts of at least 10mins, 5 days a week
- moderate exercise, aerobic
- many settings eg local gym
Cardiac Rehab MDT
- nurse specialists
- physio
- exercise specialist
- dietician
Borg Scale of Percieved Exertion:
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NICE guidelines defines a healthy body weight as
BMI of 18.5-24.9kg/m^2
Nutrition
- low sat fats
- adequate protein
- 2000 to 25000 calories a day
Cardiac Rehab: Psycho-social Management:
- screen for psychological distress: anger,
depression, anxiety - enquire about social issues:
- social isolation
- occupational issues
- marital issues
- sexual dysfunction
Barriers to completion of cardiac rehab:
- currently, uptake is 50%, aim is 85%
- most do not take part because of issues
with the service
Options to improve recruitment and completion of cardiac rehab:
- alternative delivery modes in keeping with
patients preferences eg online - home based delivery: self managed,
comparable outcome to group sessions - online delivery
- > 40% of patients would prefer multi-
modality programmes
Six standards of cardiac rehab: BACPR:
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What is cardiac rehab reviewed against?
Key performance indicators
KPIs
KPIs
- team includes at least 3 staff types
- programme inlcudes all priority groups
- phase 3 starts at least 8 weeks in
- phase 3 starts <33 days (IHD)
- phase 3 starts <46 days (CABG)
- initial assessment undertaken in hospital
- final assessment done at the end of phase
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