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CI2 > Cardiac Rehabilitation > Flashcards

Cardiac Rehabilitation Flashcards

1
Q

What are the rates of recurrence for heart attacks?

A

More than 1/3 of hospital admissions for heart attacks are repeat events

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2
Q

What does heart disease include?

A
  • Acute coronary syndrome (significant episode of angina or a heart attack)
  • Chronic heart failure
  • Other diagnoses e.g. atrial fibrilation
  • Post-op patients e.g. CABG
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3
Q

What is the prognosis for chronic heart failure?

A

No cure, progressive

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4
Q

What is the pathophysiology behind CHD?

A
  • Formation of artherosclerotic plaque in coronary artery
  • Reduces lumen size & blood flow to myocardium
  • Limits flow of oxygen & nutrients to myocardium (ischaemia)
  • Complete lack of oxygen resulting in myocardial cell death = MI (heart attack)
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5
Q

What are the medical/surgical interventions for CHD?

A
  • Coronary angioplasty (balloon)
  • Coronary stenting
  • Coronary artery bypass grafting (CABG)
  • Conservative e.g. medication, lifestyle modification
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6
Q

What are the non-modifiable risk factors for CVD?

A
  • Age
  • Male/female post-menopause
  • Genetic predisposition
  • Ethnicity
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7
Q

What are the modifiable risk factors for CVD?

A
  • High cholesterol
  • Hypertension
  • Diabetes
  • Overweight
  • Smoker
  • Physically inactive
  • Depression/psychosocial issues
  • Poor nutrition
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8
Q

What is cardiac rehab?

A
  • Coordinated system of care
  • Helps people with CVD return to an active life
  • Prevents recurrence of cardiac events or new CV conditions
  • Collaboration between health professionals
  • Typically short-term, but commonly becoming a more long-term program (continuum)
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9
Q

What is the broad aim of cardiac rehab?

A

Maximise physical, psychological & social functioning (QOL) to enable people to lead fulfilling lives with confidence

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10
Q

What are the specific aims of cardiac rehab?

A
  1. Facilitate/shorten period of recovery
  2. Promote strategies for achieving ongoing prevention goals
  3. Develop/maintain skills for long-term behaviour change & self-management
  4. Promote appropriate use of health services/medications
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11
Q

What are the core components of cardiac rehab?

A
  1. Referral & access to services
  2. Assessment & ST monitoring
  3. Recovery & LT maintenance
  4. Lifestyle modification & medication adherence
  5. Evaluation & quality improvement
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12
Q

What are the 4 traditional phases of cardiac rehab?

A
  1. Inpatient education, mobilisation (3-5 days)
  2. Supervised, outpatient group exercise & education (2-6 weeks)
  3. Maintenance program (6-12 weeks)
  4. Community-based, independent
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13
Q

What patients are eligible for cardiac rehab?

A
  • MI
  • Re-vascularisation procedures
  • Stable angina
  • Controlled heart failure
  • Valve device, replacement & repair
  • Permanent pacemaker (PPM) & implantable defibrillator insertion (ICD)
  • Heart transplant & ventricular assist device (VAD)
  • Atrial fibrillation
  • High risk of future event
  • Other vascular/heart diseases
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14
Q

What does the multidisciplinary team for cardiac rehab include?

A
  • Coordinator (nurse/allied health)
  • Cardiologist/GP
  • Nurse
  • Physio
  • EP
  • Dietitian
  • Social worker
  • OT
  • Psychologist
  • Indigenous health worker
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15
Q

What is the evidence for cardiac rehab?

A
  • Sundararajan et al 2004: 35% benefit in 5 year survival associated with cardiac rehav
  • Taylor et al 2004: Decreased all-cause mortality, cholesterol & SBP
  • Anderson et all 2016: Decreased cardiac mortality, hospital admissions over 1 year, increased QOL
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16
Q

What are some of the problems with traditional CR?

A
  • Poor uptake (10-30%)
  • Those in greatest need least likely to attend
  • Inflexible model - requires transport etc & tends to be exercise-focused
17
Q

What are some of the contemporary solutions to CR?

A
  • Case-management model
  • Often individualised
  • Telephone support & follow-up
  • More flexible
  • Engagement of physicians
  • Focus equally on risk factors
  • Longer follow-up than traditional CR
  • Home-based CR just as effective as centre-based
18
Q

What did systematic reviews by Jolliffe (2000), Clark (2005) and Clark (2007) find?

A

Programs with and without structured exercise that are either brief or long reduced death & events to a similar degree

19
Q

What were the findings of the Coach program?

A
  • Phone coaching to risk factor targets

- Significant decrease in multiple risk factors

20
Q

What were the findings of the Choice program?

A
  • Patient engagement & choice in risk factor modification & phone support
  • Significant decrease in multiple risk factors
21
Q

What were the findings of the Scrip program?

A
  • Nurse case management & phone

- Decreased TC & BP, increased CV meds

22
Q

What were the findings of the Multifit program?

A
  • Nurse case management, phone, counselling & exercise

- Decreased TC, fewer smokers, increased CV meds

23
Q

What was involved in the Text Me program?

A
  • Text messaged based prevention program

- Significant decrease in multiple risk factors

24
Q

What are the goals of phase 1 of CR?

A
  • Maintain functional capacity
  • Develop patient confidence
  • Minimise anxiety & depression
  • Maximise early discharge
  • Risk factor ID & lifestyle modifications
  • Stabilise patient
  • Control pain & arrhythmias
  • Limit myocardial damage
25
Q

What are the considerations/CIs of phase 1 of CR?

A
  • Febrile
  • Sinus tachycardia (>120bpm @ rest)
  • Anaemia
  • Wound infection
  • Unstable sternum
  • Complicated MI
26
Q

What are the considerations for a sternotomy patient?

A
  • UL exercises: Minimise adhesions, muscle shortening & atrophy, stiffness, prevents guarding
  • 6/12 for sternum to fully unit
  • Sternal PCs 8-12/52
  • Pain control
27
Q

What are the aims of phase 2 of CR?

A

Increase CV fitness, confidence to exercise & provide secondary prevention (education)

28
Q

What assessments are used in CR?

A
  • Chest & sternum
  • Mobility & exercise tolerance (ISWT, 6MWT)
  • Medical history
  • Medications
  • Investigations
  • Psychosocial (QOL, depression)
  • Goal setting
  • Risk factors
29
Q

What tests are used to assess risk factors?

A
  • Cholesterol: Blood test
  • Blood pressure
  • Heart rate: Pulse, SpO2
  • Weight: BMI, waist, WHR
  • Nutrition: Diet assessment
  • Smoking history
  • Exercise/PA
  • Diabetes (Y/N)
30
Q

What is involved in exercise testing?

A
  • 6 minute walk test
  • Shuttle walk test
  • Monitor SOB (Borg scale), HR, signs & symptoms
  • Goal is 30 mins moderate intensity PA on most weekdays
31
Q

What are the absolute CIs of exercise testing?

A
  • Progressive worsening of exercise tolerance/dyspnoea over previous 3-5 days
  • Significant ischaemia & low exercise intensities
  • Uncontrolled diabetes
  • Acute systemic illness/fever
  • Recent embolism (<4 weeks)
  • Thromboplebitis
  • Active pericarditis or myocarditis
  • Severe aortic stenosis
  • Regurgitate valvular HD requiring surgery
  • MI within previous 3 weeks
  • New onset AF
  • Resting HR > 120bpm
32
Q

What are the relative CIs of exercise testing?

A
  • 2kg increase in body mass over past 1-3 days
  • Concurrent continuous/intermittent dobutamine therapy
  • Decrease in systolic BP with exercise
  • NYHA functional class IV
  • Complex ventricular arrhythmia
  • Supine resting HR >100bpm
  • Pre-existing co-morbidities
  • Moderate aortic stenosis
  • BP> 180/10
  • SpO2<88% on room air
33
Q

What exercise training is included in CR?

A
  • CV (walking, cycling, stairs)
  • Resistance
  • Functional (daily PA)
  • Reduce sedentary behaviour
  • Independence aiming to change lifestyle
34
Q

What does general education in CR include?

A
  • Basic anatomy/physiology of heart
  • Symptom monitoring & warning signs
  • Recovery/healing process
  • Risk factors for heart disease
  • Importance of long-term behaviour change
  • Resumption of normal daily activities
  • Mood/depression/social issues
  • Medications
  • Action plan
35
Q

How is CHF managed?

A
  • Non-pharmacological strategies (PA programs etc)
  • Best practice pharmacotherapy
  • Surgical procedures & supportive devices
  • Post-discharge CHF Mx programs
  • Palliative care
36
Q

What are the CFH considerations?

A
  • Clinical condition fluctuates
  • Hospital readmissions are common
  • Closely monitor symtoms
  • Self-management is fundamental
37
Q

What are the general issues with CHF?

A
  • Monitor HR, SOB, BP, signs/symptoms, wound site
  • May need oxygen
  • Generalised weakness, oedema
  • Consider co-morbidities
  • Aim to improve ADLs
  • General PA
38
Q

What is involved in the follow-up & ongoing care for CHD?

A
  • Telephone
  • Internet
  • Lifelong change
  • GP contact
  • 6-12 months & ongoing
  • Transition to community
39
Q

What are the 4 classes of CHF?

A

I: No limitation of PA
II: Slight limitation of PA, comfortable at rest
III: Marked limitation of PA
IV: Unable to carry on any PA without discomfort, symptoms at rest

CI2 (17 decks)

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