Cardiac rehabilitation programs

Exercise intervention, lifestyle programs including smoking cessation, diet modification, control of cardiovascular risk factors, behavioral interventions psychological support and vocational components.

More than 1 million persons a year into cardiac rehabilitation program for recovery after a cardiovascular event, such as a myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, heart surgery, or heart transplant.

Only 25% of patients who have had a cardiovascular event participate in cardiac rehabilitation.

Comprehensive cardiac,rehabilitation is an outpatient chronic disease management program aimed at optimizing secondary prevention.

It is a personalized approach to provide secondary prevention, therapies for individuals with cardiovascular disease.

It is prescribed to control cardiovascular symptoms, improve exercise tolerance and quality-of-life.
Primary goal is to enable patients to achieve optimal physical, psychological, social, and vocational functioning through exercise training and lifestyle change.
it’s goals are to help patients achieve cardiovascular health and guideline directed targets to control blood pressure, lipids, weight, blood glucose, and tobacco exposure: to adhere to guideline directives, medical therapies and to control, coexisting conditions, including psychological disorders, musculoskeletal, limitations, and sleep apnea.

Core components of cardiac rehabilitation include: exercise to improve cardiovascular fitness, education, reduction or cessation of smoking, lipid management, controlling hypertension, weight loss, eating a healthy diet, controlling diabetes, increasing physical activities, and improving psychological well-being.

It reduces cardiovascular mortality by approximately 25% and hospital readmissions by 18%.

Reduces the risk of a heart attack, hospitalization, and death in patients with chronic heart failure or a history of myocardial infarction or coronary revascularization.

Cardiac rehabilitation is recommended for patients with stable angina, or with stable heart failure with a reduced ejection fraction.

The Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL Study) a randomized controlled trial for patients following standard post-myocardial infarct cardiac rehabilitation compared to a long-term reinforced multifactor educational and behavioral intervention decreased the risk of cardiovascular outcomes, particularly nonfatal myocardial infarction, although the overall effect was small.

Eligible patients should ideally begin the cardiac rehabilitation within one to two weeks after an event.

Prompt enrollment improves patient participation in such programs; participation is one percent lower for every 1 day delay in enrollment.

Early enrollment improves outcome by 67% in exercise capacity among patients who enrolled within 15 days after the hospital discharge than among patients enrolled 30 or more days after discharge.

CR improves cardiovascular outcomes including exercise capacity, cardiovascular risk factor control, social functioning, and psychological well-being, hospital remission rates, and mortality rates.

Cardiac rehabilitation in patients diagnosed with cardiovascular disease have significant lower healthcare utilization and expenditures over the long term.

Cardiac rehabilitation programs provides a comprehensive approach to chronic disease management, significantly reduces morbidity and mortality by approximately 25% over one to two years when compared to usual care for cardiovascular disease (Taylor RS et al, Ades PA et al).

Cardiac rehabilitation in a population-based study reduced mortality by 21-34% among elderly patients (Suaya JA et al).

Participating in one of more sessions of cardiac rehabilitation reduced the risk of hospital readmission or death by about 43% in patients with a history of myocardial infarction or a treatment for blocked coronary arteries.

Cardiac rehabilitation participation has been shown to reduce morbidity and mortality to a similar degree as statins, aspirin, and beta blockers (Taylor RSet al, La Rosa JC et al).

Recommended as the standard of care for acute coronary syndromes and revascularization and other cardiac populations.

Patient recommended for cardiac rehabilitation Include: myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, chronic stable angina, heart failure, peripheral arterial disease, and cardiovascular disease prevention in women.

CR utilization remains low, particularly among women.

CR participation rates are lower among women, members of an ethnic or racial minority, speaks limited English, or are of low-income.

Most eligible patients do not participate in cardiac rehabilitation at all, let alone complete recommended 36 one hour sessions.

The patient attends 36 cardiac rehab sessions, lasting one hour over a period of 12 weeks as they participate in exercise training, nutritional counseling, educational, and psychological support sessions.

Treatment plans include directed exercise, comprising, cardiovascular, resistance, flexibility, and balance training

Only about 20% of the nearly 1,000,000 patients in the US who experience heart attack, chronic heart failure, angioplasty, or heart surgery go to cardiac rehab.

Women are less likely to be referred to a CR program, to enroll in CR once referred, and to complete a full course of CR as compared with men.

More than a simple supervised exercise program, cardiac rehabilitation involves teaching patients about heart-healthy lifestyle, counseling to relieve stress and treat depression.

Under referral for cardiac rehabilitation include individuals with low educational level, multi morbidity, English as a second language, poor social support, the greater family responsibilities.

It is underutilized with only 14-35% of myocardial infarction survivors and 31% of patients after coronary artery bypass grafting participate in cardiac rehab.

Benefits from CR include improvements in functional capacity, psychological health, adherence to treatment, control of risk factors for cardiovascular disease, return to work, health related quality of life with reductions in the hospital readmission rates and cardiovascular death rates.

All-cause  mortality, benefits, are one to 2% reduction in mortality, for each cardiac rehab session attended.

The number of patients needed to attend CR to prevent one MI at 12 months is 75 and the number needed to prevent one hospital readmission is 12, the number needed to treat to prevent one death is 34 at one year and 22 at five years after PCI.

One cardiac arrest is reported for every 1.3 million patient hours of cardiac rehab exercise.

Cardiac rehabilitation is cost-effective.



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