Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease. This article updates the American Heart Association (AHA) 1. It provides a review of the recommended components of optimal rehabilitation/secondary prevention programs, ways to deliver these services, recommended future research directions, and the rationale for these recommendations, with emphasis on the exercise training component. Secondary prevention is an essential part of the contemporary care of the patient with cardiovascular disease (CVD). The term cardiac rehabilitation refers to coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality. As such, cardiac rehabilitation/secondary prevention programs provide an important and efficient venue in which to deliver effective preventive care. In 1. 99. 4, the AHA declared that cardiac rehabilitation should not be limited to an exercise training program but also should include multifaceted strategies aimed at reducing modifiable risk factors for CVD. Choose a Cardiac Rehabilitation Program. The best cardiac rehabilitation programs are multidisciplinary. Is the program certified by the American Association of Cardiovascular & Pulmonary Rehabilitation? Both our cardiac and pulmonary rehabilitation programs offer individualized exercise programs, as well as help making healthy lifestyle changes. Since then, detailed guidelines have been published that clearly specify each of the core components of cardiac rehabilitation/secondary prevention programs, along with information about the evaluation, intervention, and expected outcomes in each area. Thus, cardiac rehabilitation/secondary prevention programs currently include baseline patient assessments, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training, in addition to the appropriate use of cardioprotective drugs that have evidence- based efficacy for secondary prevention. Candidates for cardiac rehabilitation services historically were patients who recently had had a myocardial infarction or had undergone coronary artery bypass graft surgery, but candidacy has been broadened to include patients who have undergone percutaneous coronary interventions; are heart transplantation candidates or recipients; or have stable chronic heart failure, peripheral arterial disease with claudication, or other forms of CVD. In addition, patients who have undergone other cardiac surgical procedures, such as those with valvular heart disease, also may be eligible. Unfortunately, cardiac rehabilitation programs remain underused in the United States, with an estimated participation rate of only 1. Contributing to the vast underuse of these services are a low patient referral rate, particularly of women, older adults, and ethnic minority patients; poor patient motivation; inadequate third- party reimbursements for services; and geographic limitations to accessibility of program sites. In addition, there is a lack of “visibility” and recognition by the public of the importance of cardiac rehabilitation services. To potentially rectify these concerns, alternative models to the traditional hospital- or community center–based setting for outpatient programs have been developed. These models include home- based programs for which a nurse generally serves as case manager and facilitates, supervises, and monitors patient care and progress,1. Electronic media programs are an alternative method for providing home- based comprehensive risk- factor modification education and instruction for structured exercise. Additional research is required to establish the effectiveness of these non–hospital- based approaches for rehabilitation and secondary prevention and to determine how to deliver these services optimally. Exercise Training Intervention.
Guidelines for prescribing aerobic and resistance exercise for patients with CVD are available elsewhere. Specific activity recommendations also are available for women,1. Safety Considerations. The relative safety of medically supervised, physician- directed, cardiac rehabilitation exercise programs that follow these guidelines is well established. The occurrence of major cardiovascular events during supervised exercise in contemporary programs ranges from 1/5. Contemporary risk- stratification procedures for the management of coronary heart disease (CHD) help to identify patients who are at increased risk for exercise- related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants. Effect on Exercise Capacity. Exercise training and regular daily physical activities (eg, working around the house and yard, climbing stairs, walking or cycling for transportation or recreation) are essential for improving a cardiac patient’s physical fitness. Supervised rehabilitative exercise for 3 to 6 months generally is reported to increase a patient’s peak oxygen uptake by 1. Improved fitness enhances a patient’s quality of life and even can help older adults to live independently. Improved physical fitness also is associated with reductions in submaximal heart rate, systolic blood pressure, and rate- pressure product (RPP), thereby decreasing myocardial oxygen requirements during moderate- to- vigorous activities of daily living. Improved fitness allows patients with advanced coronary artery disease (CAD) who ordinarily experience myocardial ischemia during physical exertion to perform such tasks at a higher intensity level before reaching their ischemic ECG or anginal threshold. Furthermore, improvement in muscular strength after resistance training also can decrease RPP (and associated myocardial demands) during daily activities, such as carrying groceries or lifting moderate to heavy objects. In addition, improvement in cardiorespiratory endurance on exercise testing is associated with a significant reduction in subsequent cardiovascular fatal and nonfatal events independent of other risk factors. These findings also apply to patients with chronic heart failure. In a recent meta- analysis of 8. Smart and Marwick. P=0. 0. 6) associated with improved functional capacity, as well as a reduction in cardiorespiratory symptoms after aerobic and strength training. Return to Work. Although exercise training–induced improvement in functional capacity and the associated reduction in cardiorespiratory symptoms may enhance a cardiac patient’s ability to perform most job- related physical tasks, factors unrelated to physical fitness appear to have a greater influence on whether a patient returns to work after a cardiac event. These factors include socioeconomic and worksite- related issues and previous employment status. The educational and vocational counseling components of cardiac rehabilitation programs should further improve the ability of a patient to return to work. Effect on CVD Prognosis. During the past 5 decades, numerous studies have demonstrated a reduced rate of initial CHD events in physically active people. These findings, along with those from studies that demonstrate biologically plausible cardioprotective mechanisms (discussed below), provide strong evidence that regular physical activity of at least moderate intensity reduces the risk of coronary events, thus leading to the conclusion that physical inactivity is a major CHD risk factor. Burke's New York Cardiopulmonary Rehabilitation Program helps cardiac and pulmonary patients achieve the most active and productive life possible. Pulmonary and Cardiac Rehabilitation Services The simple act of breathing is not simple for those who suffer from emphysema. Norton Healthcare offers pulmonary rehabilitation programs at three locations in Jefferson County. An even greater impact is seen when the endurance exercise program is of sufficient intensity and volume to improve aerobic capacity. Data from the Health Professionals’ Follow- up Study. In the absence of definitive randomized controlled trials, meta- analyses of smaller studies have been used to assess the role of exercise training, alone or as part of a comprehensive cardiac rehabilitation program, on morbidity and mortality rates of CHD patients. Meta- analyses based on studies performed in the 1. AHA scientific statement on cardiac rehabilitation programs. Agency for Health Care Policy and Research guidelines. Subjects in these earlier trials were predominately low- risk, middle- aged, white male survivors of myocardial infarction. Women, older people, ethnic minorities, and patients who underwent revascularization procedures or who had other types of cardiac conditions were excluded or markedly underrepresented in these studies. Major advances in the management of patients with CHD during the 1. These medical advances include attenuation of residual myocardial damage from acute coronary occlusion by emergent medical interventions and pharmacological therapy to reduce myocardial oxygen demands; development and use of antiplatelet and anticoagulant drugs; prompt coronary revascularization by thrombolysis or percutaneous interventions; and more frequent use of revascularization procedures. Wider prophylactic use of adjunctive cardioprotective drugs (eg, statins), as demonstrated in definitive clinical trials, has been shown to be effective for reducing cardiovascular morbidity and mortality rates. Furthermore, biotechnical advances that have improved the survival rates of cardiac patients include conventional or drug- eluting coronary stents, implantable cardioverter defibrillators, and biventricular pacing and left ventricular assist devices for treating patients with chronic heart failure. Cardiac & Pulmonary Rehabilitation Program. We also offer smoking cessation classes and other programs that help you take control of your health. Our Cardiac Rehabilitation program gets results.In light of these advances, the additional effect of exercise training on morbidity and mortality rates in current cardiac rehabilitation participants is unclear. Taylor et al. 2 reported encouraging findings in a meta- analysis based on a review of 4. This meta- analysis, which updated an earlier study by the same investigators,3. CHD to the database from the earlier meta- analyses,3. Greater numbers of women (2. As shown in the Table, exercise- based cardiac rehabilitation was associated with lower total and cardiac mortality rates compared with usual medical care, which was in agreement with previous reports.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
January 2017
Categories |