Maintaining cardiac health after a heart

If you are one of the many Americans who suffer from cardiovascular disease, cardiac rehabilitation (cardiac rehab) may be right for you. According to the Centers for Disease Control (CDC), heart disease is the leading cause of death in the United States, with more than 800,000 people suffering from a heart attack each year. Cardiac rehab is an individualized program for people who have suffered from a heart attack, heart failure or ischemic heart disease or for those individuals who have received interventions for cardiovascular disease such as cardiac catheterization or invasive surgical procedures to replace coronary blood vessels and heart valves. This program provides a multidisciplinary team approach to stopping or reversing the progression of atherosclerotic disease (build-up of plaque in the coronary blood vessels), improving the patient’s self-confidence in living with cardiovascular disease and assisting the individual in improving overall cardiac function.

What is involved in cardiac rehab? Many think of cardiac rehab as an exercise program, but it consists of many other areas that assist one in their daily living activities, such as basic self-care, home management or work responsibilities. The multidisciplinary team may consist of several of the following: the individual’s cardiovascular physician (surgeons, cardiologist, etc.), nurse, pharmacist, dietician, behavioral therapist, case manager, physical therapist, occupational therapist and speech and language pathologist. While the multidisciplinary team members may vary within a cardiac rehab program, this team and the client and family will construct an individualized heart health plan after the initial evaluation process. The areas to be addressed within the program should include nutritional counseling, weight management, smoking cessation, management of other co-morbidities (obesity, diabetes, high cholesterol), exercise training and psychosocial management of the disease process.

When should cardiac rehab begin? The process may start while an individual is in an inpatient setting following a cardiovascular event, such as a heart attack, post-coronary artery stent placement or cardiovascular surgery. This is called the clinical phase and is a starting point for assessing the client’s physical abilities and motivation to change lifestyles with a healthy nutritional intake and regular exercise. The team will provide the client with an assessment for home needs such as assistive devices (walker, shower chair, etc.), education on techniques to deal with stressful situations, and education for the client and family on cardiovascular disease and other co-morbidities, medications and strategies to address the individual’s daily needs for living. After the initial assessment, the client is urged to limit exercise until physician clearance for cardiac rehab to move into the outpatient rehab phase.

Does cardiac rehab have to begin with an inpatient admission? No, the clinical phase may be skipped, and the process starts in the outpatient setting from a physician referral after an individual has had an office visit with the cardiologist where cardiovascular disease has been diagnosed through assessment. The processes discussed in the inpatient setting will begin upon entry into the outpatient setting. The team will assess the client’s physical activity, dietary needs, exercise tolerance and personal needs to assist with their daily living activities. There may be separate educational sessions on specific disease processes, medications and coping/relaxation strategies for dealing with stress. This phase of cardiac rehab may last six (6) to twelve (12) weeks, depending on the goals set by the client. The goal is to develop healthy heart living habits the client will utilize daily.

What happens after I am discharged from outpatient therapy? The last phase of cardiac rehab is called the post-cardiac or maintenance phase. At this time, the client should be independent with a new lifestyle and will continue to self-monitor their progress. In this phase, the client continues the exercise regimen at home or a fitness center. The daily living activities should promote an active lifestyle. The client will continue to follow up with their physicians to assess their cardiovascular status and medication requirements.

What are the overall goals of cardiac rehab?

The biggest goal is to improve the client’s quality of life by assisting them with controlling symptoms, reducing the psychological and physical effects of the disease, and enhancing functional capacity so the individual may continue their daily activities. Over time, the program’s goal is to lessen the risk of reoccurrence of cardiovascular events or sudden death, stabilize or reverse the progression of plaque formation in the coronary arteries, and reduce the symptoms seen with cardiovascular disease such as weakness and fatigue.

Does cardiac rehab really work? Research has shown that cardiac rehabilitation, when instituted with compliant clients, increases the individual’s quality of life and decreases health care costs. While exercise seems to be the most significant aspect of cardiac rehab, the educational aspects that include discussion of maintenance of disease processes, medications and strategies to cope/reduce stress empower the client to have some control in continuing those activities in their life that bring them joy.

Diana Merendino, DPT, RRT, FAARC, is an associate professor, LSU Health Shreveport.