Overview of Cardiac Rehabilitation
Cardiovascular disease, also known as heart disease, is a major cause of death all over the world, and it’s the number one cause of death in the United States. One treatment option for heart disease is something called cardiac rehabilitation, which is a customized program designed to help people with a variety of heart conditions. This program is especially helpful for people who have conditions like heart failure, heart attacks, or ischemic heart disease (reduced blood supply to the heart), and for those who have undergone heart procedures such as the widening of a blocked heart artery (coronary angioplasty) or bypass surgery (coronary artery bypass grafting).
Cardiac rehabilitation programs have several important goals. They aim to cut down on the physical and mental stress that heart disease can cause, reduce the risk of death from heart disease, and improve the functioning of the heart to help patients have the best possible quality of life. These goals are achieved by improving the overall functioning and capacity of the heart, stopping or reversing the build-up of artery-clogging plaques (atherosclerotic disease), and boosting the patient’s confidence through a process of gradual physical conditioning.
Several major health organizations, including the American Heart Association, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Agency for Health Care Policy and Research, agree on what a comprehensive cardiac rehabilitation program should include. The program should aim to reduce the risk of heart disease, lessen disability, encourage healthier lifestyle habits, and help patients continue these healthy habits long after the rehabilitation program ends. As part of this program, patients should receive:
* An evaluation of their health
* Advice on nutrition
* Help with managing their weight
* Help with controlling blood pressure
* Managed cholesterol levels
* Controlled blood sugar levels (for diabetics)
* Support to quit smoking
* Management of mental health issues
* Advice on physical activity
* Exercise training.
Why do People Need Cardiac Rehabilitation
Cardiac rehabilitation is recommended for a number of heart-related conditions. These include:
* If you’ve recently had a heart attack
* If you’ve been diagnosed with acute coronary artery syndrome, a condition where blood supply to the heart is suddenly blocked
* If you have chronic stable angina, which is chest pain or discomfort that occurs when your heart doesn’t get enough blood
* If you have congestive heart failure, a condition where your heart doesn’t pump blood as well as it should
* If you’ve recently had coronary artery bypass surgery, which is a procedure to improve blood flow to your heart
* If you’ve undergone a percutaneous coronary intervention, a non-surgical procedure used to treat narrowed coronary arteries of the heart
* If you’ve had surgery to repair or replace your heart valves
* If you’ve had a heart transplant
These are situations where doctors usually recommend cardiac rehabilitation because it helps your heart recover, lowers your risk of future heart problems, and improves your overall health.
When a Person Should Avoid Cardiac Rehabilitation
There are certain situations in which a person cannot take part in the exercise part of a heart rehabilitation program. These include:
– Unstable angina, which is a condition that causes severe chest pain due to lack of blood flow to the heart.
– Severe decompensated heart failure, when the heart can’t pump enough blood to meet the body’s needs.
– Complex irregular heart rhythms, or ventricular arrhythmias.
– Severe high blood pressure in the lungs, or pulmonary hypertension, where the pressure in the lungs is over 60 mm Hg.
– Blocking of a blood vessel by a clot that has formed inside the heart, or an intracavitary thrombus.
– Recent inflammation of a vein caused by a blood clot, or thrombophlebitis, with or without a blood clot traveling to the lungs, a pulmonary embolism.
– Severe obstructive cardiomyopathies, or abnormal heart conditions that make it harder for the heart to pump blood.
– Severe stenosis or narrowing of the aortic valve in the heart.
– Uncontrolled inflammation or infection.
– Any musculoskeletal condition, like certain bone or muscle problems, that make it hard to take part in physical exercise properly.
Who is needed to perform Cardiac Rehabilitation?
Heart treatment through a team-based approach, also known as cardiac rehabilitation, can be extremely beneficial. This specialized team is made up of several members, all of which are integral to the patient’s recovery. These include:
The patient, since they are the most important part of the recovery process. Their effort, cooperation, and positive mindset play a huge role in how successful the treatment will be.
The patient’s family, who provides moral support and assists with daily activities, making sure the patient is comfortable and stress-free.
Doctors, including surgeons (who operate if necessary), cardiologists (heart specialists), physiatrists (rehabilitation physicians), and other kinds of specialists; these professionals oversee and provide medical care.
Pharmacists, who manage the patient’s medication to make sure everything is safe and working as it should.
Nurses, who are often the first line of contact for the patient. They provide care, comfort and vital check-ups.
Physiotherapists and occupational therapists, who offer exercises and training to help the patient regain strength and learn how to perform daily activities safely after treatment.
Speech and language pathologists, who assist patients that may have trouble speaking or swallowing due to their heart condition or treatment.
Behavioral therapists, who provide strategies to cope with emotional and psychological stress, and promote healthy lifestyle habits.
Dietitians, who plan a healthy diet that can significantly improve the healing process and overall heart health.
Lastly, case managers who coordinate all these aspects and ensure that the patient’s care is seamless and well-rounded.
How is Cardiac Rehabilitation performed
Cardiac rehabilitation is typically divided into three stages.
Stage I: Hospital Phase
* In this phase, rehabilitation starts while you’re still in the hospital after a heart-related event or procedure. The aim is to assess your physical capability and readiness for rehab. Under the guidance of therapists and nurses, you might start doing simple, non-straining exercises in bed or at the bedside, with a focus on maintaining your range of motion and reducing the weakening effects of your hospital stay. The rehab team might also help you with daily activities and teach you how to avoid unnecessary stress. During this phase, you’re usually suggested to get plenty of rest until your other health issues or post-procedure complications are addressed. The rehab team will identify if you need any special equipment, educate you and your family, and plan for your discharge from the hospital.
Stage II: Outpatient Rehab
* After getting a green signal from your heart specialist and when your condition is stable, you start the next stage of your rehab. This outpatient phase usually lasts between three to six weeks, but can extend up to twelve weeks for some. Initially, a thorough assessment will identify any physical limitations or difficulties due to other health issues. Then, a personalized therapy plan that covers educating you about your condition and self-care, a suited exercise program, and a relaxation routine is created. The goal of this phase is to help you become self-sufficient, make necessary lifestyle modifications and prepare you to return to your regular life at home.
Stage III: Continuing Rehab
* This stage allows for more self-management and self-monitoring. Here, the focus is on enhancing your flexibility, strength and cardiovascular conditioning. You will be encouraged to maintain an active lifestyle and continue your exercise routine. Regular visits to heart specialists will be suggested to keep track of your heart health and medication routines. They also guide you in maintaining a healthy lifestyle and take necessary measures to prevent any setbacks.
There’s also a pre-surgery phase of cardiac rehab, where you start your heart rehabilitation before your heart surgery. Some studies show that this approach tends to make the post-surgery recovery process more manageable for patients.
Possible Complications of Cardiac Rehabilitation
A research study in France looked at how safe cardiac rehabilitation is, which is a program designed to help people with heart problems improve their health. They found that heart attacks occurred at a rate of 1.3 for every million hours that patients were exercising.
Another research study by Rakhshan and his team wanted to see if there were any complications related to heart rhythm devices not working correctly after patients went through eight weeks of cardiac rehabilitation. Interestingly, they found that the people who went through cardiac rehabilitation actually had fewer physical complications compared to a control group, who didn’t go through the rehabilitation.
What Else Should I Know About Cardiac Rehabilitation?
Cardiac rehabilitation, which involves a program of exercise and education to help people with heart problems, can greatly improve a person’s quality of life, and also reduce health care costs. The exercise part of cardiac rehab has been proven to increase how much oxygen your body can use, improve the function of your blood vessels, and increase the flow of blood to your heart. It can also help to reduce smoking, lower body weight, and decrease blood lipid levels and blood pressure. This means it can be a big help in maintaining a healthier lifestyle.
Research shows that cardiac rehab can reduce depression in heart disease patients who have had a major event like a heart attack. According to a review of medical studies, cardiac rehab can decrease the chances of needing to go into hospital and may reduce the likelihood of death in the longer term for heart failure patients.
The aim of cardiac rehab is split into two categories – short-term and long-term. It’s short-term goals include controlling symptoms of heart disease, improving physical ability, and reducing mental impact and health issues related to heart disease. It’s long-term goals include treating and stopping the progress of heart disease and lessening the chance of sudden death or heart attack.
Regarding future research, studies have found techniques like ‘e-coaching’ – which involves electronic health and fitness guidance – could be an effective way of targeting physical, clinical, and mental health. However, more details are needed to see which parts of e-coaching work best. Basic e-coaching was not found to be effective. There is also a need for more studies on the effect of cardiac rehab for people with heart disease from birth, to set up guidelines and understand the current evidence.
