Chronic stable angina rehabilitation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Cardiac rehabilitation, also called cardiac rehab (CR), is a medically supervised program to help cardiac patients recover quickly and improve their overall well being. The main goal of rehabilitation is to help patients understand their disease and inculcate a regimen to stabilize and reduce, or even reverse the progression of cardiovascular disease. Cardiac rehab is often divided into phases that involve monitored exercise, counseling, emotional support, and education about lifestyle changes to reduce the risks of heart problems. It also helps reverse limitations experienced by patients who have suffered the adverse patho-physiologic and psychological consequences of cardiac events, thus, also helping patients to return to work early. Traditionally, cardiac rehabilitation has been provided to lower-risk patients who could exercise without physical limitations. However, rapid evolution in the management of CAD has now changed the demographics of the patients, so that, even patients with recent revascularization can be candidates for rehabilitation training.

Definition

The U.S. Public Health Service definition[1] of cardiac rehabilitation states that:

Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. These programs are designed to limit physiological and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients.

Above definition clearly implies the need for multidisciplinary approach and, hence, World Health Organization divided it into three main phases which are also listed in AHA/ACC guidelines:[2]

1. Acute phase or inpatient cardiac rehab (also known as Phase 1 CR): a program that delivers preventive and rehabilitative services to hospitalized patients following an index CAD event, such as an MI/acute coronary syndrome;
2. Reconditioning phase or early outpatient cardiac rehab (also known as Phase 2 CR): a program that delivers preventive and rehabilitative services to patients in the outpatient setting early after a CVD event, generally within the first 3 to 6 months after the event but continuing for as much as 1 year after the event;
3. Maintenance phase or long-term outpatient cardiac rehab (also known as Phase 3 or Phase 4 CR): a program that provides longer term delivery of preventive and rehabilitative services for patients in the outpatient setting.

Indications for Cardiac Rehabilitation

Patients who are considered eligible for cardiac rehab include those who have experienced one or more of the following conditions as a primary diagnosis sometime within the previous year:[2]

In addition to these, there is growing evidence from published studies that suggest a benefit of CR for persons with chronic heart failure or peripheral arterial disease.

ACC/AHA Guidelines- Recommendations for cardiac rehabilitation programs in patients with chronic stable angina (DO NOT EDIT)[3][4]

Class I
"1. Comprehensive cardiac rehabilitation program (including exercise). (Level of Evidence: B)"

References

  1. Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA et al. (1995) Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute. Clin Pract Guidel Quick Ref Guide Clin (17):1-23. PMID: 8595435
  2. 2.0 2.1 Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J et al. (2007) AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons. J Am Coll Cardiol 50 (14):1400-33. DOI:10.1016/j.jacc.2007.04.033 PMID: 17903645
  3. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).Circulation 99 (21):2829-48. PMID: 10351980
  4. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758

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