Unstable angina non ST elevation myocardial infarction cardiac rehabilitation

Resident Survival Guide

Acute Coronary Syndrome Main Page
Unstable angina / NSTEMI Microchapters
Home
Patient Information
Overview
Classification
Pathophysiology
Unstable Angina
Non-ST Elevation Myocardial Infarction
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders
Epidemiology and Demographics
Risk Stratification
Natural History, Complications and Prognosis
Special Groups
Women
Heart Failure and Cardiogenic Shock
Perioperative NSTE-ACS Related to Noncardiac Surgery
Stress (Takotsubo) Cardiomyopathy
Diabetes Mellitus
Post CABG Patients
Older Adults
Chronic Kidney Disease
Angiographically Normal Coronary Arteries
Variant (Prinzmetal's) Angina
Substance Abuse
Cardiovascular "Syndrome X"
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Blood Studies
Biomarkers
Electrocardiogram
Chest X Ray
Echocardiography
Coronary Angiography
Treatment
Primary Prevention
Immediate Management
Anti-Ischemic and Analgesic Therapy
Cholesterol Management
Antitplatelet Therapy
Antiplatelet therapy recommendations
Aspirin
Thienopyridines
Glycoprotein IIb/IIIa Inhibitor
Anticoagulant Therapy
Additional Management Considerations for Antiplatelet and Anticoagulant Therapy
Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS
Mechanical Reperfusion
Initial Conservative Versus Initial Invasive Strategies
PCI
CABG
Complications of Bleeding and Transfusion
Discharge Care
Medical Regimen
Post-Discharge Follow-Up
Cardiac Rehabilitation
Long-Term Medical Therapy and Secondary Prevention
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Unstable angina non ST elevation myocardial infarction cardiac rehabilitation On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Unstable angina non ST elevation myocardial infarction cardiac rehabilitation
CDC onUnstable angina non ST elevation myocardial infarction cardiac rehabilitation
Unstable angina non ST elevation myocardial infarction cardiac rehabilitation in the news
Blogs on Unstable angina non ST elevation myocardial infarction cardiac rehabilitation
to Hospitals Treating Unstable angina non ST elevation myocardial infarction cardiac rehabilitation
Risk calculators and risk factors for Unstable angina non ST elevation myocardial infarction cardiac rehabilitation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Smita Kohli, M.D.

Overview

When feasible, cardiac rehabilitation should be considered for patients after hospitalization. These programs aim to reduce the physiological and psychological stress that occurs after cardiac illness. They are comprehensive programs which address all aspects of a patient's care. A study has found that patients undergoing cardiac rehab have a lower risk of sudden death and recurrent MI at 3 years. Physician referral is the most important predictor for patient participation in a cardiac rehabilitation program.

Definition

The U.S. Public Health Service definition 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.

”

Mechanism of Benefit

Cardiac rehabilitation, also called cardiac rehab (CR), is a medically supervised program to help cardiac patients recover quickly and improve their overall well being.

• Cardiac rehabilitation programs are designed to limit the 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.
• Cardiac rehab may occur in a variety of settings, including medically supervised groups in a hospital, physician’s office, or community facility.
• Education and counseling concerning risk factor modification are individualized, and close communication between the treating physician and cardiac rehabilitation team may promote long-term behavioral change.

Clinical Trial Data

• A randomized clinical trial of cardiac rehabilitation following MI by Witt et al found that participants in cardiac rehab programs had a lower risk of death and recurrent MI at 3 years. In this study, half of the eligible patients participated in cardiac rehabilitation after MI, although women and older adult patients were less likely to participate, independent of other characteristics. Study, however, did not show any beneficial effect on recurrence of nonfatal MI.
• Another study by Wenger et al demonstrated that cardiac rehabilitation comprising exercise training and education, counseling, and behavioral interventions yielded improvements in exercise tolerance with no significant cardiovascular complications, improvements in symptoms (decreased anginal pain and improved symptoms of HF such as shortness of breath and fatigue), and improvements in blood lipid levels; reduced cigarette smoking in conjunction with a smoking cessation program; decreased stress; and improved psychosocial well-being.
• Other studies have also shown reduction in total cholesterol, LDL-C and HDL-C as well.
• Studies have shown that fewer than one third of patients with MI receive information or counseling about cardiac rehabilitation before being discharged from the hospital. Physician referral is the most powerful predictor of patient participation in a cardiac rehabilitation program.

Reasons for Non-Participation and Non-Compliance

Physician referral is the most powerful predictor of patient participation in a cardiac rehabilitation program.

• Affordability of service,
• Insurance coverage/ noncoverage,
• Social support from a spouse or other caregiver,
• Gender-specific attitudes,
• Patient-specific internal factors such as anxiety or poor motivation, and
• Logistical and financial constraints, or a combination of these factors.

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes (DO NOT EDIT)

ED or Outpatient Facility Presentation

Class I

"1. All eligible patients with NSTE-ACS should be referred to a comprehensive cardiovascular rehabilitation program either before hospital discharge or during the first outpatient visit. (Level of Evidence: B)"

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST Elevation Myocardial Infarction (DO NOT EDIT)

Cardiac Rehabilitation (DO NOT EDIT)

Class I

"1. Cardiac rehabilitation/secondary prevention programs, when available, are recommended for patients with UA / NSTEMI, particularly those with multiple modifiable risk factors and those moderate to high risk patients who supervised or monitored exercise training is warranted. (Level of Evidence: B)"