By Riddhi Patel, MD | Image – Robert Kneschke/Shutterstock.com |
80 million Americans have cardiovascular disease and it is the leading cause of morbidity and mortality throughout the world. Cardiac rehabilitation is a comprehensive program available for patients that reduces the effects of cardiovascular disease as well as mortality.
What is cardiac rehabilitation?
The World Health Organization definition of cardiac rehabilitation is: “The sum of activity required to ensure cardiac patients the best possible physical, mental, and social conditions so that they may, by their own effort, regain as normal a place in the community, and lead an active life.” The goal of cardiac rehab is to restore quality of life and reduce morbidity and mortality.
Target populations for cardiac rehabilitation programs
Patients with ischemic heart disease who are post myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal coronary angioplasty; patients with stable angina; and patients with CHF, dysrhythmias, defibrillators/pacemakers, post-valve replacement, cardiomyopathy, aneurysm resection, heart transplant, and congenital heart defects. Other chronic diseases of stroke and peripheral vascular disease also qualify for cardiac rehab.
Phases of programs
Phase 1: Inpatient phase:
- Occurs during hospitalization for acute coronary event such as MI
- Early progressive mobilization to the level of performing basic household tasks
- Brief education about the nature of the program, illness, and risk factors
Phase 2: Early outpatient phase:
- Supervised physical activity and aggressive risk factor reduction
- Usually 3 to 6 months in duration
Phase 3: Lifetime maintenance plan
- Periodic reassessments of symptoms, risk factors, medication compliance, and psychosocial support
Cardiac rehab used to be a simple program for monitoring patients for the return to activities but it has evolved into a multidisciplinary program with many components. The core components of cardiac rehab programs are: patient identification, patient assessment, exercise training, physical activity counseling, tobacco cessation, weight management, nutrition counseling, risk factor management, and psychosocial counseling.
- 20 to 30% reduction in all-cause mortality rates
- Decreased mortality up to 5 years post rehabilitation
- Reduced symptoms
- Improved exercise performance
- Improved medication adherence
- Reduced hospitalization
- Improved quality of life
- Increased ability to work
Despite these benefits the majority of patients who are eligible do not undergo cardiac rehab. Medicare data shows that only 14% of eligible patients following MI go through rehabilitation.
What this means for providers
There are many clear benefits of cardiac rehabilitation yet the majority of eligible patients are not utilizing the program. It is important for physicians to identify patients who would benefit and help them enroll.
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- Stephens, MB. Cardiac Rehabilitation. Am Fam Physician. 2009 Nov 1;80 (9): 955-959
- American Heart Association. Facts: Cardiac Rehabilitation, Putting More Patients on the Road to Recovery. 2013.
- Lear, SA; Ignaszeski, A. Cardiac rehabilitation: a comprehensive review. Curr Control Trials Cardiovascular Med. 2001; 2 (5): 221-232
- Singh, VN. Cardiac Rehabilitation. Medscape. 2015.
- Mampuya, WM. Cardiac rehabilitation past, present, and future. 2012.