Cardiac rehab programs can improve patient health
Education is a key to successful lifestyle change
A comprehensive cardiac rehabilitation program is highly beneficial for people who have experienced a cardiac event, such as a heart attack or bypass surgery, says Murray Low, EdD, FAACVPR, FACSM, president-elect of the American Association of Cardiovascular and Pulmonary Rehabilitation.
It can reduce the risk of death after a cardiac event by 20% to 25%.
"The cardiac rehabilitation program is an independent variable in and of itself. Above and beyond everything physicians do to provide patients with optimum medical care, cardiac rehab further reduces mortality from cardiac death," says Low, who is director of cardiac rehabilitation at Stamford (CT) Hospital; The Burke Rehabilitation Hospital in White Plains, NY; Sound Shore Medical Center of Westchester in New Rochelle, NY; and Northern Westchester Cardiac Rehab in Mt. Kisco, NY.
There has been a focus on acute care of patients with coronary artery disease and acute management of their illness and complications. Secondary prevention techniques have been slow to develop, says Richard Stein, MD, a spokesperson for the American Heart Association and director of the Urban Community Cardiology Program at New York University School of Medicine in New York City.
Cardiac rehabilitation programs that include finding a lifetime activity for exercise as well as dietary and psychosocial counseling are dramatically effective in helping people make the lifestyle changes that will increase the likelihood of outliving their disease, says Stein.
An important part of successfully managing heart disease is cardiac rehabilitation yet it is not utilized very effectively in the United States, says Stein.
To remedy the problem, a new set of performance measures aimed at increasing patient enrollment in cardiac rehabilitation programs and setting standards of excellence for program operation were released in 2007 by the American Association of Cardiovascular and Pulmonary Rehabilitation based in Chicago; The American College of Cardiology in Washington DC; and the Dallas-based American Heart Association.
AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/ Secondary Prevention Services are available on each organization's web site (www.aacvpr.org, www.acc.org, and www.americanheart.org).
Cardiac rehabilitation requires a multi-disciplinary approach, and the performance measures pull all the pieces together to define a high-performing program that is providing all the necessary services, says Larry F. Hamm, PhD, FAACVPR, FACSM, 2007-08 president of AACVPR and visiting professor & director of the clinical exercise physiology program in the department of exercise science at the George Washington University Medical Center in Washington, DC.
The document does more than identify the core components of a good cardiac rehab program. It provides information on how they are delivered.
"It would be difficult to take the performance measures paper and unilaterally implement everything in it overnight. Certainly over time and in stages that would be the goal," says Hamm.
Education key element
One of the toughest lessons to teach is the importance of lifestyle change, and that is an important element of cardiac rehab, says Low. Patients must understand that a procedure, such as bypass surgery, and prescribed medications do not protect completely from the progression of the disease. If it did, then cardiac rehabilitation would not be needed.
"In our health care system, we have put the cart before the horse in that we are focused on providing medication and procedures, not dealing with the most important part, which is altering the lifestyle that led to the disease process," says Low.
The foundation of a good cardiac rehabilitation program is exercise training, says Hamm. An individualized exercise prescription is developed for each patient that is safe and effective. Then patients perform the exercise prescription in a supervised environment. In addition, patients need education on a wide array of topics, including heart disease, medications used to control symptoms, risk factors, diet related to a heart healthy lifestyle, and the importance of cardiac rehab.
Once patients have the information, they must learn how to apply it in order to reduce their risk for subsequent cardiac problems, says Hamm. For example, if a patient has high cholesterol, a diet plan must be determined in addition to medication to reduce cholesterol.
Patient education improves outcomes for cardiac patients by not only giving them information on lifestyle changes, but also teaching them how to make the changes. It's important to give people the tools to make necessary changes and then coach them or encourage them while they make the changes, adds Hamm.
In addition, greater knowledge about heart disease and how to achieve positive outcomes reduces fear and anxiety, says Stein.
The vast majority of hospitals that have a full range of cardiovascular diagnostic and intervention services offer cardiac rehab programs, says Hamm. The problem isn't so much in the availability of programs but in the referral process, he adds.
Yet there is no better way to monitor cardiac patients following discharge. In cardiac rehab, patients are seen two to three times a week in a medical setting for about three months. They are given electrocardigrams, and their blood pressure and heart rate is monitored, says Hamm. If a problem occurs, it can be communicated quickly to the patient's physician.
Patients that go through cardiac rehab and adopt the lifestyle changes afterwards do better medically, says Stein. It is not only a good investment of time and energy, but it is also very enjoyable, he adds. Essentially, the patient gets a personal trainer for three months at a very expensive gym.
"It is a wonderful way to not only lead yourself back into life, but lead yourself into an active life," says Stein.