Cardiac Rehab
Cardiac Rehab defined:
A progressive
program with a
goal of helping
patients restore
and maintain
optimal health
while helping to
reduce the risk of
future heart
problems.
Cardiac Rehab Phases
Phase I- (inpatient) assessment and
mobilization, education on risk
factors and a discharge plan
Phase II- (outpatient) exercise, risk
factor reduction, reduce
morbidity/mortality, improve
function and quality of life and build
confidence
Phase III&IV- maintenance program
Staffing
Medical Director- MD
– Available for consult
– Assist in program development
– Approve all policies/procedures
– Be involved in therapeutic aspects of
program
Coordinator- RN, Ex. Phys, RD, MBA
– Administrative duties
– Direct patient care
Staffing
Registered Nurse (RN)– Licensed
– ACLS trained
– Cardiovascular experience
Exercise Physiologists–
–
–
–
–
Bachelor’s degree
Master’s degree (preferred/required)
ACLS trained
ACSM certification (preferred)
Experience
Staffing
Registered Dietitian (RD)– ADA registered
– Master’s degree (preferred)
– Experience
Others– Administrative Assistants, Health
educator, Certified Diabetes Educator,
Mental Health Prof., P.T., O.T.,
Pharmacist
Exercise Physiologist’s role:
Inpatient visits
(recruiting)
Conduct
orientations &
assessments
Individualize
exercise
prescriptions
Manage classes
Monitor
HR/BP/ECG
response to exer.
& other
signs/symptoms
Teach education
classes
Counseling
Discharge planning
Typical Class
At least 4:1 patient/staff ratio
Hook up, 10 min. warm-up, 45
minutes cardiovascular training, 10
minutes cool down
Education classes
Facility
Rehab
Education Classes
Nutrition- RD
Medications- Pharmacist
Cholesterol, Hypertension, Anatomy
& Physiology, Stress, Weight Control,
Exercise & Your Heart, CAD, AlcoholCaffeine-Tobacco
Challenges
Physician support
Insurance requirements!
Medicare will only cover:
– MI
– CABG
– Stable Angina
Most managed care providers will
cover a majority if not all of rehab
“Ideal” Patient
57 yo, MI, PTCA/stent
Completed 36 sessions of Phase II
cardiac rehab
Lost 13 pounds
Significantly increased workloads
Tolerated exercise well w/ no
cardiovascular complaints
Success Story
71 yo male
CABGx3 & other significant heart hx
Presented w/ an unusual EKG
Patient was admitted to hospital and
received a defibrillator
“Repeat Offender”
60 yo male
Med. History-CABG 1979 & 1990
PTCA/stents- 96,97,03,04 & 05
Risk Factors= Family Hx, Stress,
Cholesterol
???
Typical Problems
73 yo male
MI, Hx of CABG
Blood Pressures= 184/80, 178/78,
170/68, etc
Physician keeps changing meds
???
Outcomes
Data collected on 217 PHD patients:
– 16.2% change in LDL cholesterol
– 11.3% change in triglycerides
– 6% change in obesity
Psychosocial Factors:
Participants who rate their health as:
Pre
Post
Excellent
8.1%
7.8%
Very Good
17.2
31.2
Good
45.9
44.9
Fair
22.5
14.6
Poor
6.2
1.5
Resources
North Texas Association of Cardiovascular
and Pulmonary Rehab (NTACVPR)
– Meetings 2nd Tuesday of every other monthNov. 8th- Presby Plano 6:30
– tacvpr.org
AACVPR.org
Presbyterian Hospital of Dallas214-345-6375
Internship opportunities