Cardiovascular Rehabilitation - PowerPoint PPT Presentation


Title: Cardiovascular Rehabilitation


1
Cardiovascular Rehabilitation
  • The Art and Science of Managing Individuals with
    Cardiovascular Disease
  • Presented by
  • Esther Burchinal, MS, ACSM CES RCEP (SM)

2
Significant Statistics
  • Cardiovascular disease
  • Claims more lives than all forms of cancer
    combined, males and females.
  • Heart Disease is the No. 1 cause of death in the
    World and in the US.
  • Causes over 375,000 American deaths/year.

American Heart Association, Dallas Texas
3
Significant Statistics
  • Nearly 735,000 Americans sustain a myocardial
    infarction each year
  • 120,000 are fatal
  • 5 of myocardial infarctions occur before age 40
  • 45 of myocardial infarctions occur before age 65

4
Significant Statistics
  • The of Americans hospitalized, undergoing
    operations and procedures, for cardiovascular
    disease increased 28 between
  • 2000-2010.
  • CVD is the first diagnosis in
  • 6,000,000 hospitalizations
  • 5,225,000 outpatient procedures
  • 65,843,000 physician office visits

5
Mission of Cardiac Rehabilitation
  • To restore and maintain an individuals optimal
    physiological, psychological, social and
    vocational status

6
Overview of Cardiovascular Rehabilitation
  • Medically supervised secondary prevention program
    for patients with diagnosed cardiovascular
    disease
  • Physician referral required
  • Generally meets three times per week for up to 12
    weeks
  • Risk stratification process based on probability
    of future event and disease progression

7
Phases of Cardiac Rehab
  • Phase I during hospitalization
  • Phase II early outpatient
  • - Supervised program with telemetry
    monitoring, exercise, education, and support.
  • -Usually 2-4 weeks post event lasting
    3-6months.
  • Phase III lifetime maintenance.

8
Continuum of Care Model
  • Initial Assessment ? Problem List ?
  • Goal Setting ? Plan of Care ?
  • Plan Implementation ? Outcomes Evaluation

9
Core Program Components
  • Baseline patient assessment
  • Risk factor management
  • Nutritional counseling
  • Psychosocial management
  • Physical activity counseling
  • Exercise training
  • Balady, G. et al. Core components of cardiac
    rehabilitation/secondary prevention programs A
    statement for healthcare professionals from the
    American Heart Association and the American
    Association of Cardiovascular and Pulmonary
    Rehabilitation. Circulation, 2000 1021069-1073.

10
Common Program Components
  • Initial and on-going evaluation
  • Monitored sessions
  • EKG
  • HR, RPE, Talk test
  • BP
  • Signs/symptoms
  • Lifestyle education sessions
  • Support group

11
Common Program Components
  • Initial and ongoing evaluation typically
    includes
  • Medical history
  • Risk factor identification and assessment
  • Psychosocial and quality of life indicators
  • Functional assessment
  • Exercise prescription

12
Common Program Components
  • Patients are monitored for
  • Exercise related physiologic parameters
  • Wound healing/sternotomy integrity
  • Emotional status
  • Muscular-skeletal status
  • Risk factor management (i.e. hypo/hypertension,
    diabetes management, medication management)

13
Common Program Components
  • Lifestyle education sessions
  • Individual and/or group interactions targeting
  • Risk factor education, intervention, and
    modification including
  • Exercise Activity, Heart Disease, Medications,
    Nutrition, Stress Physiology Stress Management
  • Support group

14
Approved Diagnoses
  • Medicare Guidelines
  • Angina
  • Myocardial Infarction
  • Coronary Artery Bypass Graft
  • Heart Transplant
  • Valve Surgery
  • Stent
  • Coronary Artery Disease (CAD)
  • Heart Failure (EF lt 35)

15
Approved Diagnoses
  • Non-Medicare Beneficiaries
  • Myocardial infarction
  • Stable angina
  • CABG
  • PTCA/stent placement
  • Heart transplant
  • call for verification
  • Heart failure
  • Cardiomyopathy
  • Recent ICD implant
  • Arrhythmias
  • Valve replacement/repair

16
Multidisciplinary Team Approach May Include
  • Medical Director
  • Referring Physician
  • Registered Nurse
  • Exercise Physiologist
  • Registered Dietitian
  • Physical Therapist
  • Licensed Social Worker
  • Pharmacist
  • Occupational Therapist
  • Health Educator
  • Other consulting practitioners

17
Certifications and Accreditations
  • American Heart Association
  • Basic Life Support (BLS)
  • Advanced Cardiac Life Support (ACLS)
  • American Association of Cardiovascular and
    Pulmonary Rehabilitation
  • Program Certification
  • Certified Cardiac Rehabilitation Professional
    (CCRP)

18
Certifications and Accreditations
  • American College of Sports Medicine
  • Certified Exercise Specialist (CES) bachelors
    prepared
  • Registered Clinical Exercise Physiologist (RCEP)
    masters prepared
  • American Nurses Credentialing Center
  • Others RD, LICSW
  • For hospitals JCAHO, now called TJC

19
Benefits of Participation
  • Improved functional abilities
  • Improved Quality of Life
  • Reduction of lifestyle related risks
  • Increased knowledge of disease process and
    prevention strategies
  • American Heart Association Consensus Panel
    Statement. Preventing heart attack and death in
    patients with coronary disease. Circulation.
    1995922-4.

20
Benefits of Participation
  • Improved compliance with medical regimen
  • Improved metabolic profile
  • Malbut-Shennan, K. and Young, A. The physiology
    of physical performance and training in old age.
    Coronary Artery Dis. 19991037-42.
  • Gottlieb, S.S., Fisher, M.L., and Freudenberger,
    R. et al Effects of exercise training on peak
    performance and quality of life in congestive
    heart failure patients. Journal of Cardiac
    Failure, 19995188-194.
  • Lavie, C.J., Milani, R.V., and Littman, A.B.
    Benefits of cardiac rehabilitation and exercise
    training in secondary coronary prevention in the
    elderly. J Am Coll Cardiol. 199322678-683.
  • Agency for Health Care Policy and Research, U.S.
    Department of Health and Human Services. Cardiac
    Rehabilitation Clinical Practice Guidelines.
    Publication No. 96-0672, October 1995.

21
Benefits of Participation
  • Reduced risk of fatal MI (lt25).
  • Decreased severity of angina need for
    anti-angina meds.
  • Decreased hospitalizations.
  • Decreased cost of physician office visits
    hospitalizations (lt35).
  • Decreased ER visits.
  • Ades, PA, et al (2000) Medical Clinics of North
    America
  • Sudlow, C, et al (1999) Clinical Evidence
  • Lavie, CJ, et al (1999) Cardiology Clinics

22
Utilization Trends
  • Nearly 2 million Americans are eligible for
    secondary prevention
  • On average, only 10 to 30 of eligible patients
    receive cardiac rehabilitation
  • (Ranges vary between 11 and 38 depending on the
    area of the country.)

23
Dose Response Relationship for CR Sessions and
Risk of Death / MI 36 vs 24
36 vs 12 36 vs 1 Death - 14
- 22 - 47 MI - 12
- 23 - 31 Relationship
Between Cardiac Rehabilitation and Long-Term
Risks of Death and Myocardial Infarction Among
Elderly Medicare Beneficiaries. Hammill, BG. et
al. Circulation. 201012163
24
What can we do?
  • Continue to educate ourselves and the public
    about risk factors, heart disease, and Cardiac
    Rehab
  • Learn CPR and AED use
  • Lead by example
  • Join professional organizations MACVPR, ACSM,
    CEPA, MACEP..

25
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Cardiovascular Rehabilitation

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Transcript and Presenter's Notes

Title: Cardiovascular Rehabilitation


1
Cardiovascular Rehabilitation
  • The Art and Science of Managing Individuals with
    Cardiovascular Disease
  • Presented by
  • Esther Burchinal, MS, ACSM CES RCEP (SM)

2
Significant Statistics
  • Cardiovascular disease
  • Claims more lives than all forms of cancer
    combined, males and females.
  • Heart Disease is the No. 1 cause of death in the
    World and in the US.
  • Causes over 375,000 American deaths/year.

American Heart Association, Dallas Texas
3
Significant Statistics
  • Nearly 735,000 Americans sustain a myocardial
    infarction each year
  • 120,000 are fatal
  • 5 of myocardial infarctions occur before age 40
  • 45 of myocardial infarctions occur before age 65

4
Significant Statistics
  • The of Americans hospitalized, undergoing
    operations and procedures, for cardiovascular
    disease increased 28 between
  • 2000-2010.
  • CVD is the first diagnosis in
  • 6,000,000 hospitalizations
  • 5,225,000 outpatient procedures
  • 65,843,000 physician office visits

5
Mission of Cardiac Rehabilitation
  • To restore and maintain an individuals optimal
    physiological, psychological, social and
    vocational status

6
Overview of Cardiovascular Rehabilitation
  • Medically supervised secondary prevention program
    for patients with diagnosed cardiovascular
    disease
  • Physician referral required
  • Generally meets three times per week for up to 12
    weeks
  • Risk stratification process based on probability
    of future event and disease progression

7
Phases of Cardiac Rehab
  • Phase I during hospitalization
  • Phase II early outpatient
  • - Supervised program with telemetry
    monitoring, exercise, education, and support.
  • -Usually 2-4 weeks post event lasting
    3-6months.
  • Phase III lifetime maintenance.

8
Continuum of Care Model
  • Initial Assessment ? Problem List ?
  • Goal Setting ? Plan of Care ?
  • Plan Implementation ? Outcomes Evaluation

9
Core Program Components
  • Baseline patient assessment
  • Risk factor management
  • Nutritional counseling
  • Psychosocial management
  • Physical activity counseling
  • Exercise training
  • Balady, G. et al. Core components of cardiac
    rehabilitation/secondary prevention programs A
    statement for healthcare professionals from the
    American Heart Association and the American
    Association of Cardiovascular and Pulmonary
    Rehabilitation. Circulation, 2000 1021069-1073.

10
Common Program Components
  • Initial and on-going evaluation
  • Monitored sessions
  • EKG
  • HR, RPE, Talk test
  • BP
  • Signs/symptoms
  • Lifestyle education sessions
  • Support group

11
Common Program Components
  • Initial and ongoing evaluation typically
    includes
  • Medical history
  • Risk factor identification and assessment
  • Psychosocial and quality of life indicators
  • Functional assessment
  • Exercise prescription

12
Common Program Components
  • Patients are monitored for
  • Exercise related physiologic parameters
  • Wound healing/sternotomy integrity
  • Emotional status
  • Muscular-skeletal status
  • Risk factor management (i.e. hypo/hypertension,
    diabetes management, medication management)

13
Common Program Components
  • Lifestyle education sessions
  • Individual and/or group interactions targeting
  • Risk factor education, intervention, and
    modification including
  • Exercise Activity, Heart Disease, Medications,
    Nutrition, Stress Physiology Stress Management
  • Support group

14
Approved Diagnoses
  • Medicare Guidelines
  • Angina
  • Myocardial Infarction
  • Coronary Artery Bypass Graft
  • Heart Transplant
  • Valve Surgery
  • Stent
  • Coronary Artery Disease (CAD)
  • Heart Failure (EF lt 35)

15
Approved Diagnoses
  • Non-Medicare Beneficiaries
  • Myocardial infarction
  • Stable angina
  • CABG
  • PTCA/stent placement
  • Heart transplant
  • call for verification
  • Heart failure
  • Cardiomyopathy
  • Recent ICD implant
  • Arrhythmias
  • Valve replacement/repair

16
Multidisciplinary Team Approach May Include
  • Medical Director
  • Referring Physician
  • Registered Nurse
  • Exercise Physiologist
  • Registered Dietitian
  • Physical Therapist
  • Licensed Social Worker
  • Pharmacist
  • Occupational Therapist
  • Health Educator
  • Other consulting practitioners

17
Certifications and Accreditations
  • American Heart Association
  • Basic Life Support (BLS)
  • Advanced Cardiac Life Support (ACLS)
  • American Association of Cardiovascular and
    Pulmonary Rehabilitation
  • Program Certification
  • Certified Cardiac Rehabilitation Professional
    (CCRP)

18
Certifications and Accreditations
  • American College of Sports Medicine
  • Certified Exercise Specialist (CES) bachelors
    prepared
  • Registered Clinical Exercise Physiologist (RCEP)
    masters prepared
  • American Nurses Credentialing Center
  • Others RD, LICSW
  • For hospitals JCAHO, now called TJC

19
Benefits of Participation
  • Improved functional abilities
  • Improved Quality of Life
  • Reduction of lifestyle related risks
  • Increased knowledge of disease process and
    prevention strategies
  • American Heart Association Consensus Panel
    Statement. Preventing heart attack and death in
    patients with coronary disease. Circulation.
    1995922-4.

20
Benefits of Participation
  • Improved compliance with medical regimen
  • Improved metabolic profile
  • Malbut-Shennan, K. and Young, A. The physiology
    of physical performance and training in old age.
    Coronary Artery Dis. 19991037-42.
  • Gottlieb, S.S., Fisher, M.L., and Freudenberger,
    R. et al Effects of exercise training on peak
    performance and quality of life in congestive
    heart failure patients. Journal of Cardiac
    Failure, 19995188-194.
  • Lavie, C.J., Milani, R.V., and Littman, A.B.
    Benefits of cardiac rehabilitation and exercise
    training in secondary coronary prevention in the
    elderly. J Am Coll Cardiol. 199322678-683.
  • Agency for Health Care Policy and Research, U.S.
    Department of Health and Human Services. Cardiac
    Rehabilitation Clinical Practice Guidelines.
    Publication No. 96-0672, October 1995.

21
Benefits of Participation
  • Reduced risk of fatal MI (lt25).
  • Decreased severity of angina need for
    anti-angina meds.
  • Decreased hospitalizations.
  • Decreased cost of physician office visits
    hospitalizations (lt35).
  • Decreased ER visits.
  • Ades, PA, et al (2000) Medical Clinics of North
    America
  • Sudlow, C, et al (1999) Clinical Evidence
  • Lavie, CJ, et al (1999) Cardiology Clinics

22
Utilization Trends
  • Nearly 2 million Americans are eligible for
    secondary prevention
  • On average, only 10 to 30 of eligible patients
    receive cardiac rehabilitation
  • (Ranges vary between 11 and 38 depending on the
    area of the country.)

23
Dose Response Relationship for CR Sessions and
Risk of Death / MI 36 vs 24
36 vs 12 36 vs 1 Death - 14
- 22 - 47 MI - 12
- 23 - 31 Relationship
Between Cardiac Rehabilitation and Long-Term
Risks of Death and Myocardial Infarction Among
Elderly Medicare Beneficiaries. Hammill, BG. et
al. Circulation. 201012163
24
What can we do?
  • Continue to educate ourselves and the public
    about risk factors, heart disease, and Cardiac
    Rehab
  • Learn CPR and AED use
  • Lead by example
  • Join professional organizations MACVPR, ACSM,
    CEPA, MACEP..

25
Questions ?
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