Cardiac Rehabilitation

1. Cardiac Rehabilitation Best “Medicine” for your patients with Coronary Artery Disease Why you should write the “Prescription” TODAY!

2. Mission of Cardiac Rehab To restore and maintain an individual’s optimal physiological, psychological, social and vocational status.

3. Goals of Cardiac Rehab • Identify, modify, and manage risk factors to reduce disability/morbidity & mortality • Improve functional capacity • Alleviate/lessen activity related symptoms • Educate patients about the management of heart disease • Improve quality of life

4. Core Program Components • Risk factor management • Baseline & ongoing patient assessment • Exercise/activity training

5. What is Cardiac Rehabilitation? • Medically supervised • Lifestyle modification • Monitored progressive exercise/activity • Inpatient-Outpatient-Maintenance (Phase I, II, III) • Individualized, typically 3x/week, up to 12 weeks • Physician Referral Required

6. DiseaseManagementComponents • Population Identification processes • Evidence-based practice guidelines • Collaborative practice models • Patient self-management education • Process and outcomes measurement, evaluation, and management • Routine reporting/feedback loop

7. What Diagnoses are Covered? • Medicare Guidelines: • Stable Angina • Myocardial Infarction • Coronary Artery Bypass Graft • Private insurance coverage may vary

8. Utilization Benefits: • Reduced risk of fatal MI (<25%). • Decreased severity of angina & need for anti-angina meds. • Decreased hospitalizations. • Decreased cost of physician office visits & hospitalizations (<35%). • Fewer ER visits.

9. Physician Benefits: Partnership in case management provides: • Enhanced access to physician services • Consistent surveillance for improved clinical outcomes • Improved patient satisfaction • Patient education for self directed care • Feedback on medications, exercise response and other appropriate issues

10. Patient Benefits: • Improved functional capacity • Increased knowledge of heart disease • Improved adherence to positive lifestyle changes • Better compliance with medical regime • Increased self-esteem and confidence • Reduced subsequent morbidity & mortality r/t CAD

11. Lifestyle Benefits: Risk Factor and Lifestyle Modification • Smoking cessation • Lipid improvement • Blood pressure control • Exercise guidance • Weight management • Diabetes control • Stress management

12. Significant Statistics • Cardiovascular disease accounts for almost 50% of all deaths in the U.S. • Cardiovascular disease affects 13.5 million Americans each year • Nearly 1.5 million Americans sustain myocardial infarctions each year American Heart Association, Dallas Texas

13. Utilization Trends • Nearly 12.5 million Americans are eligible for cardiac rehab (secondary prevention) • On average only 15% of these eligible candidates receive cardiac rehabilitation • ranges between 11% and 30% depending on the area of the country

14. Risk Factors • Tobacco • Smoking and Chew • 50% decreased risk of CHD 1 year after cessation • Hypertension • 90% middle-aged Americans will develop HTN • 35 million office visits/yr for HTN

15. Risk Factors • Hyperlipidemia • 105,000,000 people with a tot chol > 200 • 10% reduction in TC = 30% reduction in incidence of CAD • Physical Inactivity • $76 billion • > 60% of Americans don’t get sufficient exercise

16. Risk Factors • Obesity • More than 50% women and 60% men are overweight or obese • Nearly 300,000 American adults die of causes related to obesity • Diabetes • 58% reduction by lifestyle intervention • 75% of people w/DM die of CAD or vascular disease

17. Exercise Research • Direct relation between inactivity and cardiovascular mortality. Inactivity is an independent risk factor for of CAD. • Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for CAD. • Physical fitness has been clearly associated with improvements in lipid profiles.

18. Medical Research • Cardiac Rehab Professionals remain educated on the latest medical research • New information is presented to your patients, so they can make informed decisions with you, their physician

19. Cost-effectiveness/Cost-efficiency • Medicare payments in hospital for CVD in 1997 was $26.9 billion! • Studies, adjusted for quality of life, show savings of $4,950-$9,200 per year of life saved. • Reduction in re-hospitalizations and medical costs are well documented.

20. Cardiac Rehab Professionals Partners in Patient Care: • Medical Director • Referring Physician • Registered Nurses • Exercise Physiologists • Dieticians/Nutritionists • Social Services/Psychosocial • Pharmacists

21. Who can Refer a Patient? Site-specific Policy: • Cardiologist • Primary Care Physician • Internist

22. Communication with Rehab? Collaborative Approach: • Initial referral/plan of care • Periodic Progress reports • Program oversight by Medical Director • Open ended lines of communication

23. Cardiac Rehab adds Value • Cardiac patients have many disease processes and lifestyle concerns that have contributed to their heart disease. • Cardiac rehab serves the needs of each cardiac patient and works toward secondary prevention. • Cardiac rehab adds VALUE to your patient care and increases QUALITY OF LIFE!

24. CARDIAC REHABILITATION: A REFERRAL IS A PHONE CALL AWAY!