A presentation on Outpatient Cardiac Rehab

Prepared for a seminar on phases of cardiac rehabilitation

1. Outpatient Cardiac Rehab AND Secondary Prevention Presented by- Divya Sharma Guided by- Dr. Poonam PARULEKAR

2. In this presentation Definition of cardiac rehabilitation Phases of cardiac rehabilitation Secondary prevention In the outpatient setting – Screening, Risk stratification Goal setting Intervention Maintenance

3. Cardiac REHABILITATION A medically supervised exercise program beginning soon after a cardiac event Aimed at helping individuals to return to optimal physical states and perform their ADLs A holistic approach Improves quality of life and reduces morbidity and mortality in survivors of cardiac events.

4. PHASES OF CARDIAC REHABILITATION Phase 1- Acute phase Phase 2- Subacute phase Phase 3- Intensive Outpatient Therapy Phase 4- Maintenance Phase

5. SECONDARY PREVENTION Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by- detecting and treating disease or injury as soon as possible to halt or slow its progress encouraging personal strategies to prevent reinjury or recurrence implementing programs to return people to their original function to prevent long-term problems. EARLY DETECTION RISK FACTOR MODIFICATION CARDIAC REHABILITATION

6. CARDIAC REHABILITATION AND SECONDARY PREVENTION

7. GOALS OF OUTPATIENT CR AND SP PROGRAMS This can be achieved by- To reduce CVD morbidity and mortality Improve physical and psychological function Enhance the quality of life Aggressive change of health and lifestyle behaviours Optimal medical therapy

8. GENERAL CARE PATHWAY

9. RISK FACTOR ASSESSMENT All patients should be assessed for the presence and extent of modifiable cardiovascular disease risk factors, including smoking, physical inactivity and sitting time, obesity, dietary pattern, psychosocial dysfunction including depression, exercise capacity, hypertension, dyslipidaemia, impaired glucose tolerance, and diabetes.

10. AHA- ACSM GUIDELINES

11. ACSM GUIDELINES

12. PATIENT CENTRED GOAL SETTING Depending on the medical history and physiological and psychological status, the majority of patients should begin aggressive, optimal SP while still in the hospital and should continue after discharge. FITT PRINCIPLE

13. INTERVENTION Early outpatient CR/SP should begin within 1 to 3 weeks of discharge from the hospital. Most patients, including those with uncomplicated PTCA, should begin within 1 week of hospital discharge. Automatic referral should be offered to all eligible patients to increase referral rates.

14. INTERVENTION Sessions are most commonly scheduled for 3 days per week, although they may vary based on the clinical profile. The intensity of clinical supervision is usually highest during the early initiation phase and may include ECG monitoring. More intense clinical supervision is required for patients who are at a higher level of acuity, who exhibit new or recurring cardiovascular or other symptoms, or who experience a change in health status.

15. INTERVENTION Enhanced awareness of patient status during exercise is prudent when the intensity of the exercise prescription is increased. Monitoring of clinical parameters before, during and after the completion of exercise protocol The safety and efficacy of the exercise program can be maximized through communicating with patients and conducting and implementing frequent clinical and symptomatic assessment for well-being and clinical status, as well as for compliance with the exercise prescription

16. NOTE- THE RISK OF AN UNTOWARD CARDIAC EVENT IS THE HIGHEST WHILE RESUMING UNACCUSTOMED ACTIVITY LEVELS **

17. SELF TAUGHT MEASURE- RPE SCALE

18. INTENSIVE CR AND SP A more intensive approach to exercise within CR/SP, along with innovation in the process of risk factor modification (e.g., use of coaching), is indicated as a potential avenue to improve services for many patients. Offering sessions lasting 90 to 120 min, up to 5 days per week, is within these revised regulations. Additionally, modifications to the exercise prescription such as increased duration and intensity (on some days) may be indicated and allowable.

19. MAINTENANCE CR AND SP CHD patients who have completed early outpatient CR/SP or who have CVD risk factors can benefit from attending a maintenance CR/SP. This can facilitate ongoing and additional health behavior change associated with reductions in recurrent CVD events. Patients are monitored less intensively than in early outpatient CR/SP. Exercise progression and cardiovascular indicators should be closely monitored for changes in clinical status that may warrant further evaluation. **FITT PRINCIPLE

20. MAINTENANCE CR AND SP Group lectures, individual chart reviews and newsletters can be included Group lectures can be an innovative way of uplifting the psychological status and ensuring continued motivation Leisure activities, yoga, tai-chi, sport activities can be included identifying barriers to maintenance CR/SP, such as financial considerations, transportation issues, time constraints, and orthopedic limitations

21. Cardiac rehabilitation doesn’t change your past, but it can help you improve your heart’s future. -AHA

22. REFERENCES AACVPR- CARDIAC REHAB ACSM guidelines for exercise prescription