Cardiac RehabCardiac Rehab

Cardiac Rehab defined:Cardiac Rehab defined:A progressive A progressive program with a program with a goal of helping goal of helping patients restore patients restore and maintain and maintain optimal health optimal health while helping to while helping to reduce the risk of reduce the risk of future heart future heart problems.problems.

Cardiac Rehab PhasesCardiac Rehab PhasesPhase I- (inpatient) assessment and Phase I- (inpatient) assessment and mobilization, education on risk mobilization, education on risk factors and a discharge planfactors and a discharge planPhase II- (outpatient) exercise, risk Phase II- (outpatient) exercise, risk factor reduction, reduce factor reduction, reduce morbidity/mortality, improve function morbidity/mortality, improve function and quality of life and build and quality of life and build confidenceconfidencePhase III&IV- maintenance programPhase III&IV- maintenance program

StaffingStaffingMedical Director- MDMedical Director- MD– Available for consultAvailable for consult– Assist in program developmentAssist in program development– Approve all policies/proceduresApprove all policies/procedures– Be involved in therapeutic aspects of Be involved in therapeutic aspects of

programprogram

Coordinator- RN, Ex. Phys, RD, MBACoordinator- RN, Ex. Phys, RD, MBA– Administrative dutiesAdministrative duties– Direct patient careDirect patient care

StaffingStaffingRegistered Nurse (RN)-Registered Nurse (RN)-– LicensedLicensed– ACLS trainedACLS trained– Cardiovascular experienceCardiovascular experience

Exercise Physiologists-Exercise Physiologists-– Bachelor’s degreeBachelor’s degree– Master’s degree (preferred/required)Master’s degree (preferred/required)– ACLS trainedACLS trained– ACSM certification (preferred)ACSM certification (preferred)– ExperienceExperience

StaffingStaffing

Registered Dietitian (RD)-Registered Dietitian (RD)-– ADA registeredADA registered– Master’s degree (preferred)Master’s degree (preferred)– ExperienceExperience

Others-Others-– Administrative Assistants, Health Administrative Assistants, Health

educator, Certified Diabetes Educator, educator, Certified Diabetes Educator, Mental Health Prof., P.T., O.T., Mental Health Prof., P.T., O.T., PharmacistPharmacist

Exercise Physiologist’s role:Exercise Physiologist’s role:Inpatient visits Inpatient visits (recruiting)(recruiting)

Conduct Conduct orientations & orientations & assessmentsassessments

Individualize Individualize exercise exercise prescriptionsprescriptions

Manage classesManage classes

Monitor HR/BP/ECG Monitor HR/BP/ECG response to exer. & response to exer. & other other signs/symptomssigns/symptoms

Teach education Teach education classesclasses

Counseling Counseling

Discharge planningDischarge planning

Typical ClassTypical Class

At least 4:1 patient/staff ratioAt least 4:1 patient/staff ratio

Hook up, 10 min. warm-up, 45 Hook up, 10 min. warm-up, 45 minutes cardiovascular training, 10 minutes cardiovascular training, 10 minutes cool downminutes cool down

Education classesEducation classes

FacilityFacility

RehabRehab

Education ClassesEducation Classes

Nutrition- RDNutrition- RD

Medications- PharmacistMedications- Pharmacist

Cholesterol, Hypertension, Anatomy Cholesterol, Hypertension, Anatomy & Physiology, Stress, Weight Control, & Physiology, Stress, Weight Control, Exercise & Your Heart, CAD, Alcohol- Exercise & Your Heart, CAD, Alcohol-Caffeine-TobaccoCaffeine-Tobacco

ChallengesChallengesPhysician supportPhysician supportInsurance requirements!Insurance requirements!Medicare will only cover:Medicare will only cover:– MIMI– CABGCABG– Stable AnginaStable Angina

Most managed care providers will Most managed care providers will cover a majority if not all of rehabcover a majority if not all of rehab

““Ideal” PatientIdeal” Patient

57 yo, MI, PTCA/stent 57 yo, MI, PTCA/stent

Completed 36 sessions of Phase II Completed 36 sessions of Phase II cardiac rehabcardiac rehab

Lost 13 poundsLost 13 pounds

Significantly increased workloadsSignificantly increased workloads

Tolerated exercise well w/ no Tolerated exercise well w/ no cardiovascular complaintscardiovascular complaints

Success StorySuccess Story

71 yo male71 yo male

CABGx3 & other significant heart hxCABGx3 & other significant heart hx

Presented w/ an unusual EKGPresented w/ an unusual EKG

Patient was admitted to hospital and Patient was admitted to hospital and received a defibrillator received a defibrillator

““Repeat Offender”Repeat Offender”

60 yo male60 yo male

Med. History-CABG 1979 & 1990Med. History-CABG 1979 & 1990

PTCA/stents- 96,97,03,04 & 05PTCA/stents- 96,97,03,04 & 05

Risk Factors= Family Hx, Stress, Risk Factors= Family Hx, Stress, Cholesterol Cholesterol

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Typical ProblemsTypical Problems

73 yo male73 yo male

MI, Hx of CABGMI, Hx of CABG

Blood Pressures= 184/80, 178/78, Blood Pressures= 184/80, 178/78, 170/68, etc170/68, etc

Physician keeps changing medsPhysician keeps changing meds

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OutcomesOutcomes

Data collected on 217 PHD patients:Data collected on 217 PHD patients:– 16.2% change in LDL cholesterol16.2% change in LDL cholesterol– 11.3% change in triglycerides11.3% change in triglycerides– 6% change in obesity6% change in obesity

Psychosocial Factors:Psychosocial Factors:

Participants who rate their health as:Participants who rate their health as:

PrePre PostPost

Excellent Excellent 8.1% 7.8%8.1% 7.8%

Very GoodVery Good 17.2 17.2 31.231.2

GoodGood 45.945.9 44.944.9

FairFair 22.522.5 14.614.6

PoorPoor 6.26.2 1.51.5

ResourcesResourcesNorth Texas Association of Cardiovascular North Texas Association of Cardiovascular and Pulmonary Rehab (NTACVPR)and Pulmonary Rehab (NTACVPR)– Meetings 2Meetings 2ndnd Tuesday of every other month- Tuesday of every other month-

Nov. 8Nov. 8thth- Presby Plano 6:30- Presby Plano 6:30– tacvpr.orgtacvpr.org

AACVPR.orgAACVPR.org

Presbyterian Hospital of Dallas- Presbyterian Hospital of Dallas-

214-345-6375 214-345-6375

Internship opportunitiesInternship opportunities