CAD
Cardiac Rehabilitation
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Cardiac Rehabilitation
, Activity after Myocardial Infarction
See Also
Chest Pain
Cardiac Risk Factor
s
Angina
Angina Diagnosis
Unstable Angina
TIMI Risk Score
Acute Coronary Syndrome
Acute Coronary Syndrome Immediate Management
Acute Coronary Syndrome Adjunctive Therapy
High Risk Acute Coronary Syndrome Management
Moderate Risk Acute Coronary Syndrome Management
Low Risk Acute Coronary Syndrome Management
Myocardial Infarction Stabilization
Serum Cardiac Marker
s
Electrocardiogram in Myocardial Infarction
Echocardiogram in Myocardial Infarction
Goldman Criteria for ICU Chest Pain Admission
Background
Cardiac Rehabilitation is under-utilized by Medicare-eligible indications (only 14-31% participation)
Cardiac Rehabilitation has great efficacy as a secondary prevention tool
Indications
Medicare reimbursed indications (3 sesssions per week for 3 months)
Following acute
Myocardial Infarction
(
STEMI
or non-
STEMI
) in the last 12 months
Status-post
Coronary Artery Bypass Graft
(
CABG
)
Status-post
Percutaneous Coronary Intervention
(PCI)
Stable
Angina Pectoris
Status-post Vascular Surgery
Status-post
Heart Transplantation
Status-post
Heart Valve
Repair or Replacement
Recent CVA (women only)
Other indications
Stable
Congestive Heart Failure
with reduced left-ventricular ejection fraction
Peripheral Arterial Disease
Status-post
Ventricular Assist Device
placement
Pacemaker
or
Implantable Cardioverter-Defibrillator
Protocol
Cardiac Rehabilitation Phases
Gene
ral
Standard programs
Exercise
training program for a total of a 36 session program over 12 weeks
Medicare covers up to two, 1 hour sessions per day
Intensive programs (limited availability)
Intensive programs may include up to 72 sessions over up to 18 weeks
Medicare approved programs
Dean Ornish Program for Reversing Heart Disease
Pritikin Intensive Cardiac Rehab Program
Benson-Henry Institute Cardiac Wellness Program
Phase I Cardiac Rehabilitation (during hospitalization for acute event or procedure)
Supervised, structured early
Physical Activity
Patient Education
Risk stratification (low level, graded,
Exercise
tolerance testing)
Phase II Cardiac Rehabilitation (Early Outpatient)
Supervised
Physical Activity
program
Reassess symptom-limited
Exercise
tolerance
Custom tailored
Exercise Prescription
for 30 minutes daily and 5 days weekly
Monitoring of
Blood Pressure
, pulse, cardiac rhythm
Maintain
Blood Pressure
<140/90 mmHg
Nutrition counseling
May involve education on cooking and grocery shopping
Diabetes Mellitus
Type II control with
Hemoglobin A1C
<8%
LDL Cholesterol
<100 mg/dl (preferable <70 mg/dl)
Body Mass Index
reduction towards goal of <27 kg/m2 (ideally <25 kg/m2)
Cardiac Risk Factor
modification
Tobacco Cessation
Reassess cardiac symptoms at rest and with activity
Psychosocial support to screen for and manage
Major Depression
Phase III Cardiac Rehabilitation (Late Outpatient)
Maintain and reinforce phase I and II management
Reinforce medication use,
Patient Education
Protocol
Activity restrictions following acute
Myocardial Infarction
Gradually increase activity over 6-8 weeks following MI
Return to work by 8 weeks after MI
Activity program may start by 3-4 weeks after MI
Sexual activity restarted at 4-6 weeks after MI
See Sexual Intercourse after
Myocardial Infarction
Protocol
Other Measures
Influenza Vaccine
each year
Efficacy
Reduced
Angina
,
Dyspnea
, and
Fatigue
Reduced
Major Depression
after acute coronary event
Exercise
performance improved
Activities of Daily Living
(ADL) performance improved
Quality of life improved
Decreased re-hospitalization rate
Decreased work absence
Reduced age-adjusted cardiovascular mortality by 50%
References
Bondestam (1995) Am J Cardiol 75:767-71 [PubMed]
Milani (2007) Am J Med 120(9): 799-806 [PubMed]
References
Leon (2005) Circulation 111(3): 369-76 [PubMed]
Stephens (2009) Am Fam Physician 80(9): 955-60 [PubMed]
Servey (2016) Am Fam Physician 94(1): 37-43 [PubMed]
Wenger (2008) J Am Coll Cardiol 51(17): 1619-31 [PubMed]
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