Week 7 Cardiac Rehabilitation

Question 1

What is cardiac rehab?

Answer 1

Structured and supervised exercise program performed after a major cardiac event or surgery that involves multiple different phases and elements of care

Question 2

Components of cardiac rehab

Answer 2

patient assessment
nutrition counseling
weight acceptance
BP management
lipid management
Diabetes management
Tobacco cessation
Psychosocial management
Physical activity counseling
exercise training

Question 3

structure of cardiac rehab

Answer 3

Typically involves 36 sessions over 12 weeks
Involves exercise, diet/nutritional counseling, and patient education
Offers education on nutrition, exercise programming, tobacco cessation, psychosocial issues, medical management (DM, BP, cholesterol)

Question 4

Qualifying for cardiac rehab

Answer 4

Medicare Part B will cover cardiac rehab if the patient has been diagnosed with certain conditions: MI in last 12 months, CABG, ACS, after angioplasty/PCI, transplant, chronic stable angina, valve repair/replacement, heart transplant
Graded exercise test sometimes required prior to initiating CR

Question 5

Phase 1: clinical

Answer 5

Inpatient care – nursing/rehab-led

Question 6

Phase 2: outpatient

Answer 6

36 visits over ~12 weeks lasting 45-60 minutes
Warm up, exercise, warm down with monitoring of vitals
Use heart rate reserve (HRR): [HR max – RHR]
40-60% HRR (mod) or 60-80% (vigorous)

Question 7

Phase 3: maintenance

Answer 7

Progressive independence and self-monitoring of symptoms and health

Question 8

Benefits of cardiac rehab

Answer 8

47% lower mortality risk and 31% lower risk of repeat MI if attending 36 sessions of CR
Decreased risk of hospital readmission
Better quality of life
Lower cost to healthcare system

Question 9

Barriers to cardiac rehab

Answer 9

Geographic location – 30% less likely to participate if living outside of a large city
Time
Income – individuals earning >$75k a year 2x as likely to participate in CR
Wait times

Question 10

Cardiac rehab contraindications

Answer 10

Unstable angina
Severe cardiomyopathy or aortic stenosis
Infection
MSK conditions preventing exercise
Pulmonary hypertension
Acute/decompensated HF
Ventricular arrhythmias

Question 11

Cardiac rehab team

Answer 11

Patient and family
Physicians – surgeon, cardiologist, primary care, etc.
Nursing
Pharmacist
PT/OT
Exercise physiologists
Dietitian
Case manager/social worker
Therapist