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An overview of Cardiac Rehabilitation - The Heart Foundation

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An overview of Cardiac Rehabilitation - The Heart Foundation

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Refrence: Heart Foundation Australia (2015)

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cardiovascular disease (disease or medical condition)

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Here is a short overview of cardiac rehabilitation and why it's an important component of your road to recovery following a heart event.

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Reference: Coosa Valley Medical Centre. (2016). retrieved from: http://www.cvhealth.net/clinical-services/cardiac-pulmonary-rehab/

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Reference: Chogle, Dr. Sachin. Aveerat Health and Therapy Centre: Functional Fitness and Physical Rehabilitation Centre. (2016). retrieved from:
http://www.aveerat.com/cardiac-and-pulmonary-rehabilitation.html

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Normal Artery vs. Coronary Heart Disease

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Normal Artery vs. Coronary Heart Disease

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Reference:
Blauson gallery (2014). Wikiversity Journal of Medicine. Retrieved from:
https://en.wikipedia.org/wiki/Coronary_artery_disease
DOI:10.15347/wjm/2014.010. ISSN 20018762

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Anderson, L., Thompson, D. R., Oldridge, N., Zwisler, A.-D., Rees, K., Martin, N., et al. (2016). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews (16).

Australian Cardiovascular Health and Rehabilitation Association (ACRA) (2015). [Accessed March 14, 2016] Retrieved from http://www.acra.net.au/wp-content/uploads/2015/01/Practitioner-Guidelines-Section-1.pdf

Australian Institute of Health and Welfare. (2015). Cardiovascular Disease. Retrieved from

http://www.aihw.gov.au/cardiovascular-disease/

Blauson gallery (2014). Wikiversity Journal of Medicine. Retrieved from:
https://en.wikipedia.org/wiki/Coronary_artery_disease
DOI:10.15347/wjm/2014.010. ISSN 20018762

Chogle, Dr. Sachin. Aveerat Health and Therapy Centre: Functional Fitness and Physical Rehabilitation Centre. (2016). retrieved from:
http://www.aveerat.com/cardiac-and-pulmonary-rehabilitation.html

Cohen, B., Taylor, J & Hull, K. (2013). Memmler’s The human body in health and disease (12th ed.). Wolters Kluwer Health; Lippincott Williams & Wilkins

Coosa Valley Medical Centre. (2016). retrieved from: http://www.cvhealth.net/clinical-services/cardiac-pulmonary-rehab/

Department of Health. (2015).  Cardiovascular Disease. Retrieved from

http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-cardio

Department of Health, W. A. (2014). Cardiovascular Rehabilitation and Secondary Prevention Pathway Principles for Western Australia. Cardiovascualr Health Network: Health Strategy and Networks.  Retrieved from http://www.healthnetworks.health.wa.gov.au/docs/1405_CRSP_Pathway_Principles_WA.pdf

Health Direct Australia. (2015). Living with coronary heart disease. Retrieved from

http://www.healthdirect.gov.au/living-with-coronary-heart-disease

Heart Foundation Australia (2015) Overview of Cardiac Rehabilitation. Retrieved from https://www.youtube.com/watch?v=2AB12xD6LmI

Lavie, C., J., & Milani, R, V. (2011) Progress in Cardiovascular Diseases. Cardiac Rehabilitation and Exercise Training in Secondary Coronary Heart Disease Prevention. Volume 53, Issue 6, May–June 2011, Pages 397–403 doi:10.1016/j.pcad.2011.02.008

Mampuya, W. (2012). Cardiac rehabilitation past, present and future: an overview . Cardiovascular Diagnosis.  Mar; 2(1): 38–49.

doi:  10.3978/j.issn.2223-3652.2012.01.02

National Heart Foundation of Australia, A. C. R. A. (2014). Recommended Framework for Cardiac Rehabilitation Heart Foundation Australia.

National Heart Foundation of Australia (2016. Recommended framework for Cardiac Rehabilitation. National Heart Foundation of Australia and Cardiac Rehabilitation Association. [Accessed March 14, 2016]
Retrieved from: http://heartfoundation.org.au/images/uploads/publications/Recommended-framework.pdf

Singh, V. N., & Schocken, D. D. (2015, August 12). Cardiac Rehabilitation. Medscape .

Thakkar, J. B., & Chow, K. C. (2014). Adherence to secondary prevention therapies in acute coronary syndrome. The Medical Journal of Australia , 106-109.

Woodruffe, S., Neubeck, L., Clark, R. A., Gray, K., Ferry, C., Finan, J., . . . Briffa, T. G. Australian Cardiovascular Health and Rehabilitation Association (ACRA) Core Components of Cardiovascular Disease Secondary Prevention and Cardiac Rehabilitation 2014. Heart, Lung and Circulation, 24(5), 430-441. doi:10.1016/j.hlc.2014.12.008

Yohannes, A. M., Doherty, P.,  Bundy, C., & Yalfani, A. (2010) Journal of Clinical Nursing. The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life Volume 19, Issue 19-20, pages 2806–2813, October 2010. DOI: 10.1111/j.1365-2702.2010.03313.x

Youngman, D. J. (2015). Outpatient Cardiac Rehabilitation: Best Practice Guidelines for Health Professionals. Queensland Health.  Retrieved from https://www.health.qld.gov.au/publications/best_practice/9115cardiac_doc.pdf

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Substantial research suggests that cardiac rehabilitation is the most effective method for prevention of acute cardiac complications for patients with a high risk of developing coronary artery disease or have a past history with cardiac complications. Cardiac rehabilitation is hugely beneficial for patients with little risk factors. It is readily available, cost effective and flexible, and improves one's quality of life. (Refer to cardiac rehabilitation benefits, nursing implications and improvement on patient quality of life). The advantages of cardiac rehabilitation fair outweigh any risks/disadvantages. The inclusions of cardiac rehabilitation are: Exercise programs, education of the heart, counselling  and behaviour modification to reduce stress, monitoring the patient(s) progress and healthy lifestyle to promote the patient(s) quality of life.

S00147018 - Hannah Scarlett, S00153949 - Sarah Coffey, S00182006 - Thi Luu, S00193092 - Penny Mihaloudakis

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- Severe exercise-induced ischemia E.G. Angina
- Complex ventricular arrhythmias E.G. Tachycardia
- Hypotensive response to exercise (Drop of systolic pressure due to exercise)
- Low functional capacity
- Cardiac rehabilitation does not reduce the risk of myocardial infarction or revascularisation
- Studies found no significant difference in the impact of exercise-based cardiac rehabilitation
- Study results showed that there we no signs of reducing total mortality
- Cost issues associated with cardiac rehabilitation E.G. Smoking cessation program is more cost effective than cardiac rehabilitation
- Cardiac rehabilitation remains underused
- There are low present rates of major complications such as serious injuries, myocardial infarction, cardiac arrest and death
- Various social, psychological, medical and demographic variables have an impact on cardiac rehabilitation referral and participation E.G. Age, sex, race, physician recommendation
- Inequalities in cardiac rehabilitation referral and participation against women, elders and minorities
- People who have co-morbidities which will contraindicate with cardiac rehabilitation E.G. Heart failure, Hypertension, any musculo-skeletal condition that prohibits physical exercise
- Non-adherence to change of lifestyle E.G. Diet, exercise, cessation smoking, behavioural strategies
- Non-adherence with medications E.G. Missing doses
- Therapy is a complex regimen
- Poor patient-provider relationship
- Health professionals lack of time and lack incentive
- Poor continuity of care from the health system
- Lack of access to services, pharmacies and transport for those in rural areas
- Peoples' beliefs about their illness, their expectations about cardiac rehabilitation, feelings of self-efficacy, mood and coping style
- People do not have enough knowledge and are not educated enough
- Women have poorer participation rates than men E.G. Some barriers to women's participation include the lack of financial resources, transportation difficulties, and the lack of social or emotional support
- Older individuals (elderly) are less likely to be referred to and to participate in cardiac rehabilitation
- Racial and ethnic minority populations have higher rates of cardiovascular disease but are at a disadvantage E.G. Limited participation rates to cardiac rehabilitation programs due to lack of accessibility to program sites, lack of insurance coverage and low patient referral rates

(Anderson, et al., 2016; Mampuya, 2012; Singh & Schocken, 2015; Thakkar & Chow, 2014)

Thi Luu - S00182006

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The benefits and demand for cardiac rehabilitation programs are significantly increasing in modern cardiology.
A qualitative study conducted on participants undertaking cardiac rehabilitation spoke of a common distress, disbelief and denial surrounding a CHD diagnosis. The study revealed those who were involved in cardiac rehabilitation found benefits and improvement in their emotional and physical health, ultimately leading to an increased quality of life and overall psychosocial wellbeing.
Many people diagnosed with CHD utilise secondary prevention methods to prevent subsequent coronary events, hospitalisation and death as a result of cardiac causes
- Early detection in a person's CHD process and application of early intervention strategies can halt progression of the disease, prevent recurrence of cardiac events, and reduce the risk of developing new cardiac problems
- Cardiac rehabilitation serves as an investment in your future health and general wellbeing
- Enhances ones working ability, social activities and increases independence
- Promotes positive lifestyle change
- Assists patient's in regaining their autonomy
- Increased effect on cardiac functioning with improved blood pressure and cholesterol levels
- Reduction in smoking
- Symptom relief, both temporary and long-term
- Therapeutic education to improve one's symptom awareness and self-care management, ultimately educating patient's to be responsible and autonomous for their medical treatment and on the importance of maintaining a healthy heart
- Decreases probability of hospital admission and readmission
- Minimise cardiac mortality rates
- Safer participation in physical activity in a rehabilitatiosetting with trained and experienced staff, who provide     individually tailored exercise programs established to ensure the rehabilitation is person-centred, focusing on the individuals needs and physical and mental capacity
- Trials in cardiac rehabilitation exercise therapy have demonstrated a slowing of the atherosclerotic process, and therefore a decrease in coronary illness mortality rates
- Exercise therapy increases the functional capacity of the cardiovascular system and decreases myocardial oxygen demand at all level of physical exertion
- Improvements in behavioral characteristics through stress management and other self-control tools to decrease the risk of psychiatric illnesses such as depression, anxiety, somatization, and hostility, which are often associated with a diagnosis of CHD

(Yohannes, et al., 2010; Lavie & Milani, 2011; ACRA, 2015; Mampunya, 2012)

Sarah Coffey - S00153949

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Coronary Heart Disease is caused by a process known as  atherosclerosis, the gradual build-up of substances such as cholesterol in the arteries of the heart. Often called plaque,  this substance makes the arteries narrower, so the heart has to work harder to pump blood through them. (The Department of Health, 2015).

Atherosclerosis, the most common form of CHD, starts when fat is deposited in your arteries which restricts blood flow. If the plaque forms a crack or partial blockage, only angina (chest pain) may result.

Angina is a temporary chest pain or discomfort. It happens when not enough oxygen-rich blood is owing to an area of your heart muscle because one of the coronary arteries is too narrow. The common cause of angina is coronary heart disease.
Stable Angina – infrequent and controlled with medication
Unstable Angina-  unpredictable with less pattern discernable. Thrombosis formation occurs then can progress to a myocardial infarction (Health Direct Australia, 2015).

A myocardial infarction usually happens when an area of plaque cracks. Blood cells and other parts of the blood stick over the damaged area and form a clot that suddenly and completely blocks the blood how to your heart muscle. As a result, some of the heart muscle starts to die. If the artery stays blocked, the lack of blood permanently damages the area of your heart muscle that is supplied by that artery.  (Cohen, Taylor & Hull, 2013).

Risk Factors of CHD:
-      Smoking

-      High levels of certain fats and cholesterol in the blood

-      High blood pressure

-      High levels of sugar in the blood due to diabetes or insulin resistance

-      Lack of exercise

-      Older age

-      Weight

-      History of heart disease ( Cohen, Taylor & Hull, 2013).

Nursing implications/considerations include:

-      Instruct patient to notify nurse immediately when chest pain occurs.- educate patient on chest pain

-      Assess and document patient response to medication.

-      Identify precipitating event, if any: frequency, duration, intensity, and location of pain.

-      Observe for associated symptoms: dyspnea, nausea and vomiting, dizziness, palpitations, desire to micturate.

-      Place patient at complete rest during anginal episodes.

-      Monitor heart rate and rhythm.

-      Monitor vital signs every 5 minutes during initial anginal attack.

-      Stay with patient who is experiencing pain or appears anxious.

-      Maintain quiet, comfortable environment. Restrict visitors as necessary.- mental/ emotional stress increases myocardial workload

-      Provide oxygen and medications if needed  (Cohen, Taylor & Hull, 2013).

Cardiovascular disease (CVD) is the leading cause of death and disease burden in Australia.

Increasing age, being male, being an Aboriginal or Torres Strait Islander person and having a family history of early death from coronary heart disease are also risk factors. (Health Direct Australia, 2015).

In 2011-12, an estimated 3.7 million Australians were affected by circulatory diseases, including around 1 million people with cardiovascular conditions such as stroke and heart disease; other conditions affecting a high number of people include high cholesterol and high blood pressure (Australian Institute of Health and Welfare, 2015).

S00193092-Penny Mihaloudakis

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What is it:

Cardiac rehabilitation is a medically supervised program that helps improve the health and well-being of people who have heart conditions or have a high risk of developing cardiac issues by decreasing their risk of future hospitalisations and cardiac complications (Youngman, 2015).

Rehabilitation programs include exercise training, education on heart healthy living, and counselling to reduce stress and help you return to an active life, they can be both inpatient and outpatient programs and run over a mid to long term basis (Department of Health, Western Australia, 2014).

Depending on the patient and their health risk, the patient may get a referral to cardiac rehabilitation by a GP or Primary Care Nurse if they are at risk of or have a low complexity cardiac condition. Patients suffering from major cardiac events or have more complex health issues, would be appointed a case manager in addition to a referral - such as a Cardiac Rehabilitation Coordinator or Heart Failure Nurse - who will assess and plan a rehabilitation program prior to discharge (Youngman, 2015).
Rehabilitation programs run through tertiary hospitals or other health facilities, and are available throughout Australia with over 150 Victorian locations. Cardiac rehabilitation is covered by Medicare Part B if referral requirements are met and also through private health insurance (National Heart Foundation of Australia, 2014).

Patients that are eligible for cardiac rehab include:

·       Myocardial infarction (ST elevation MI, non-ST elevation MI)

·       Re-vascularisation procedures

·       Stable or unstable angina

·       Controlled heart failure

·       Other vascular or heart disease.

Cardiac rehabilitation involves the initial assessment of the patient and their risk, gaining an understanding of their health literacy, psychosocial needs, and family support (National Heart Foundation of Australia, 2014). Rehabilitation should commence as soon as possible or suitable after diagnosis. Once patient needs have been identified, strategies surrounding medication adherence, risk factors, and self-management, and psychosocial health are implemented. This stage varies in duration and intensity, usually from 4-12 weeks, and is dependent on the patient and their needs. Following this is ongoing support - including periodic assessments and reinforcement, and necessary referrals which are lifelong and should not be time-limited (National Heart Foundation of Australia, 2014).

Aims of Cardiac rehabilitation:

·     Increase patient physical activity level and exercise safely

·     Increase patient mobilisation and self-management

·     Implement and adhere to a heart healthy diet

·     Reduce risk factors for future cardiac complications and hospitalisations

·     Improve psychosocial and emotional health

·     Improve patient quality of life

Multidisciplinary treatment team: treatment teams may include some of the following health professionals who work together with the patient to improve their quality of life and reduce health risks.

·       Doctors (GP, cardiac specialist, or surgeon),

·       Nurse

·       Exercise specialists

·       Physical and occupational therapists

·       Dieticians or nutritionists

·       Psychologists

·       Mental health specialists

·       Case manager (if required)

Woodruffe, S., Neubeck, Lis., Clark, Robyn A., et al. (2014). Australian Cardiovascular Health and Rehabilitation Association (ACRA) Core Components of Cardiovascular Disease Secondary Prevention and Cardiac Rehabilitation 2014. Heart, Lung and Circulation, 24(5), 430-441. doi:10.1016/j.hlc.2014.12.008
Youngman, D. J. (2015). Outpatient Cardiac Rehabilitation: Best Practice Guidelines for Health Professionals. Queensland Health.  Retrieved from https://www.health.qld.gov.au/publications/best_practice/9115cardiac_doc.pdf
S00147018 - Hannah Scarlett