Cardiac Rehabilitation - Significance and Procedure

Introduction

Cardiovascular diseases are one of the preeminent causes of death and the most prevalent disease in the United States. Cardiac Rehabilitation or cardiac rehab is a guiding, interprofessional intervention program planned for heart patients to help them recover completely from heart disease and achieve a healthy lifestyle in the long run. It is a medically supervised program for heart patients that enhances their general health after treatment. Cardiac rehab improves the heart’s future and can quality of life. It takes place in an outpatient clinic or a hospital setup.

Who Can Take a Cardiovascular Rehabilitation Program?

Cardiac rehab helps patients who have undergone treatments for the below conditions to return to normal life.

• Myocardial infarction (a blockage in the heart's blood vessels).

• Heart failure (a clinical condition in which the heart cannot pump enough blood).

• Arrhythmia (irregular, fast heartbeat due to abnormalities in impulse generation).

• Coronary artery disease (imbalance between oxygen supply and oxygen demand).

• Cardiovascular interventions include angioplasty and stenting (a procedure to widen the blocked blood vessels).

• Coronary artery bypass surgery (It is a procedure to treat coronary artery disease and helps to restore blood flow to the heart by creating a new route around the blockage for the blood to pass).

• Heart valve repair or replacement.

• Heart transplantation.

• Chronic stable angina.

• Congenital heart disease.

• Pacemaker or implantable cardioverter defibrillator (ICD).

• Heart attack in the last twelve months.

What is the Significance of Cardiac Rehabilitation?

• Cardiac rehab boosts the confidence, self-esteem, and determination to face the world and kick-start a normal healthy life.

• It brings down the stress and anxiety the person undergoes after a cardiac treatment.

• A medically supervised team with a multidisciplinary approach will help the patient improve their function and quality of life, strengthening the body and heart.

• Evidence supports that the person having undergone cardiac rehab has reduced hospital stays, a marked increase in physical activities, e.g., walking, and their oxygen dependency and ventilation significantly reduced. It can decrease the incidence of death by 35% after a heart attack or bypass surgery.

• Cardiac Rehabilitation is tailored to provide treatment to all, irrespective of age, and gender, with personal attention to individual needs and proper planning according to the risk factor profile through repeat assessment and reassessment throughout the program. The risk factors are evaluated using parameters such as

  • Gender.

  • Age.

  • Previous cardiac history.

  • Diabetes mellitus.

  • Smoking.

  • Obesity.

  • Stress.

  • Hypertension.

  • Alcoholism.

  • Occupation.

The American Heart Association recommends cardiac rehabilitation programs. It aims to facilitate lifestyle maintenance, monitor risk factors, and prevent reoccurrence,

focusing primarily on

• Counseling.

• Blood pressure management.

• Diabetes management.

• Tobacco cessation.

• Exercises.

• Psychological management.

• Weight management.

What Does Cardiac Rehab Consist Of?

It has four main parts -

• Counseling and training.

• Education.

• Physical activity.

• Medical Evaluation.

There are three phases to Rehabilitation; they are

1. Clinical phase: This phase begins immediately after the intervention in the hospital setting. Initially, the patient's power or ability and risk factors to tolerate the rehab and medical limitations are assessed. Therapists start by guiding patients through non-strenuous exercises in the bed or at the bedside, focusing on a range of motion and limiting hospital deconditioning. The rehabilitation team also focuses on activities of daily living and educates the patient on avoiding stress. The evaluations help the team track the patient's progress. The team also assesses the physical condition through cardiac imaging, electrocardiogram (EKG), blood glucose levels, and stress test (a test to assess how well the heart pumps blood and the oxygen supply and demands are met). Based on the study, the patient's needs, family education, and discharge planning are done.Patients are advised to remain rested until the treatment completes for comorbid conditions or postoperative complications.

2. Outpatient Cardiac Rehab: Once a patient is stable and cleared the assessment, outpatient cardiac rehabilitation begins. Phase II ideally lasts for three to six weeks though some may last up to twelve weeks.

3. Exercises: The healthcare team suggests exercises with a low risk of injury and complications and keeps track of medical reports. Aerobic exercises like walking and riding a cycle under the supervision of a personal trainer are allowed. Muscle-strengthening exercises are suggested twice or thrice a week to increase muscular fitness. The exercises have the following steps:

• Warm-up: Gradually increase the pulse rate by safely preparing the body for exercise. Benefits include raising the muscle temperature, speed of muscle action, and preparing the mind for exercise.

• Main Exercise Session: Continuous or intermittent exercise, depending upon the patient's status.

• Cool Down Phase: Bring the body back to its resting state because older hearts take a long time to return to their resting state.

• Monitoring Vitals: Monitoring vital signs such as body temperature, pulse rate, respiration rate, and blood pressure.

• Diet: The team focuses on healthy lifestyle changes such as eating a balanced, heart-healthy diet, quitting alcohol and smoking, and managing hypertension, diabetes, and cholesterol through healthy food habits. The program also includes yoga, which has been proven good for cardiac health. The nutritionist helps the patient create a healthy eating plan. Rehabilitation classes are taken to quit smoking.

The team provides psychological and emotional support for issues like depression, anxiety, staying away from professional and social life, and sexual issues. The team advises some relaxation skills to help manage and reduce stress. Counseling helps with finding healthy ways to cope with depression and anxiety. This program provides a platform to meet others who have undergone similar situations. They help in rebuilding life both emotionally and physically. A successful cardiac rehab program depends entirely on the individual's willpower and participation. Recovery can be easy if the patient cooperates well.

What Does Post-cardiac Rehab and Maintenance Consist?

The patient is encouraged to be independent and self-monitor, focusing mainly on flexibility, strengthening, and aerobic conditioning. Monitoring risk factors and secondary prevention is also advised. It includes:

• Support team.

• Outreach programs.

• Exercise program by qualified gym trainers.

• Attachment with Physicians and primary health care.

• Educational webinars and sessions.

• Telephonic follow-ups.

What Does the Rehab Team Consist Of?

The rehab requires a multidisciplinary approach involving

• A cardiologist or physician.

• Nurse.

• Physiotherapist.

• A coordinator to lead the rehabilitation team.

• Nutritionist or dietician.

• Pharmacist.

• Occupational therapist.

• Psychiatrist.

• Psychologist.

• Smoking cessation counselor.

A well-trained, skilled, and experienced staff with respect for the professional skills of all other disciplines involved in the team is a prerequisite to providing great results.

How Long Is Cardiac Rehabilitation?

The program's intensity and duration depend on the patient's medical condition. The program continues for around three months but can happen anywhere between two to eight months. Generally, the patient needs to continue the learned habits for the rest of their life to prevent a second attack. Most hospitals suggest a 12-week rehab program with 36 sessions with three one-hour sessions weekly.

Conclusion:

One of the most significant benefits of this program is the development of overall health, quality of life, and more years of survival. The benefits of cardiac rehabilitation are more than cardiac treatment. Participating in cardiac rehabilitation puts a whole team of people on the patient’s side to help recover faster so that the patient can get stronger in just a few months and learn new skills to improve the quality of life. The program proves to be helpful after getting out of the hospital.