IHD & Cardiac Rehabilitation Flashcards
Definition
Coordinated sum of activities required to favourably influence the underlying cause of CVD
Goals
Recovery
Secondary Prevention
Adoption & Maintenance of Healthy Lifestyle
Preservation of Mobility and
Self-Sufficiency
Return to Work
Cost-Effectiveness for the Health Service
Components
Exercise Education Psychological support Risk factor modification Medical Risk Management
Delivery
Multidisciplinary team approach Cardiac rehabilitation specialist nurses Physiotherapists Dietician Administrator Clinical lead Psychologist/Psychology practitioners Pharmacist Occupational therapist
Six core components
Lifestyle, risk factor and management
Pyschosocial health
Medical risk management
Six standards for cardiac rehabilitation
Qualified and competent MDT
Prompt identification, referral and recruitment of eligible patients
Early initial assessment
Early provision of structured CV prevention and rehabilitation programme
Upon completion - final assessment
Register and submit data to NACR
Eligible population
Acute coronary syndrome
Coronary revascularisation
Heart failure
Stable angina, peripheral arterial disease, post cerebrovascular event
Post implantation of cardiac defibrillators and resynchronization devices
Post heart valve repair/replacements
Post heart transplantation and ventricular assist devices
Adult Congenital Heart Disease (ACHD)
Patient’s Pathway
Cardiac rehabilitation to begin as soon as possible after admission
Lifestyle changes to include information on diet,activity,smoking
Drug therapy treatment and offer an assessment of left ventricular function to all patients who have had an M.I.
Communication of diagnosis and advice on secondary prevention, including future management plan
Psychological status
Anxiety and depression, if not treated or managed can lead to poor cardiac rehabilitation outcomes.
All patients should undergo a valid assessment including anxiety and depression ,assessment of other relevant psychological factors including illness perception and self efficacy for health behavior change and assessment of quality of life (using appropriate tools).
Agreed referral pathway to appropriately trained professionals for individuals with clinical levels of anxiety or depression and for those demonstrating signs of psychological illness. (BACPR 2017)
Depression post event
High rates of depression documented following cardiac events
Prevalence rates for depression in MI vary between 15.5% and 31%
Depression after MI is a significant predictor of cardiac mortality
Depression often over looked in patients with CHD- possibly only 25% of depressed patients actually diagnosed
The recent national audit (NACR 2014)shows that depression is reduced by 4% in patients attending cardiac rehabilitation.NACR 2016 shows this figure is now 5%.
CHD patient’s psychological challenges
Frightening, life-threatening event
(MI, Cardiac surgery or intervention)
Medication side effects
(lethargy, impotence)
Fears for family and partner being left alone
Threat to employment and financial status
Being treated differently by other people
Neurological impairment
(esp. following cardiac arrest)
Making lifestyle changes e.g. smoking, diet, activity
Barriers to uptake - patient
Lack of interest, reluctance to change lifestyle
Age, gender, ethnicity
Depression
Work or family commitments, (self employed)
Rural residence
Lack of family support
Failure to understand gravity of situation/denial
Barriers to uptake - service
Location and accessibility
Parking
Cost of transport
Schedule convenience
Socioeconomic status
Barriers to uptake - professional
Referral source, Strength of cardiologist’s recommendation for participation
Referral prejudice( age, race, gender)
Knowledge, attitudes, encouragement
Importance of Rapid Treatment in STEMI
Antiplatelet agents (aspirin + clopidogrel)
AND
“Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow
‘Primary’ angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow
