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Cardiac Rehab

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.

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Cardiac Rehab

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  1. Cardiac Rehab

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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 Exercise Physiologist’s role:

  8. 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

  9. Facility

  10. Rehab

  11. Education Classes • Nutrition- RD • Medications- Pharmacist • Cholesterol, Hypertension, Anatomy & Physiology, Stress, Weight Control, Exercise & Your Heart, CAD, Alcohol-Caffeine-Tobacco

  12. 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

  13. “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

  14. Success Story • 71 yo male • CABGx3 & other significant heart hx • Presented w/ an unusual EKG • Patient was admitted to hospital and received a defibrillator

  15. “Repeat Offender” • 60 yo male • Med. History-CABG 1979 & 1990 • PTCA/stents- 96,97,03,04 & 05 • Risk Factors= Family Hx, Stress, Cholesterol • ???

  16. Typical Problems • 73 yo male • MI, Hx of CABG • Blood Pressures= 184/80, 178/78, 170/68, etc • Physician keeps changing meds • ???

  17. Outcomes • Data collected on 217 PHD patients: • 16.2% change in LDL cholesterol • 11.3% change in triglycerides • 6% change in obesity

  18. Psychosocial Factors: • Participants who rate their health as: PrePost 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

  19. Resources • North Texas Association of Cardiovascular and Pulmonary Rehab (NTACVPR) • Meetings 2nd Tuesday of every other month- Nov. 8th- Presby Plano 6:30 • tacvpr.org • AACVPR.org • Presbyterian Hospital of Dallas- 214-345-6375 • Internship opportunities

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