Chronic stable angina rehabilitation: Difference between revisions

Jump to navigation Jump to search
Line 15: Line 15:


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 <ref name="pmid17903645">Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17903645 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. [http://dx.doi.org/10.1016/j.jacc.2007.04.033 DOI:10.1016/j.jacc.2007.04.033] PMID: [http://pubmed.gov/17903645 17903645]</ref>:
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 <ref name="pmid17903645">Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17903645 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. [http://dx.doi.org/10.1016/j.jacc.2007.04.033 DOI:10.1016/j.jacc.2007.04.033] PMID: [http://pubmed.gov/17903645 17903645]</ref>:
: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;
: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;
: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.
: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==
==Indications for Cardiac Rehabilitation==

Revision as of 14:58, 23 January 2013

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

Home

Patient Information

Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
Mixed Angina
Nocturnal Angina
Postprandial Angina
Cardiac Syndrome X
Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

Prognosis

Diagnosis

History and Symptoms

Physical Examination

Test Selection Guideline for the Individual Basis

Laboratory Findings

Electrocardiogram

Exercise ECG

Chest X Ray

Myocardial Perfusion Scintigraphy with Pharmacologic Stress

Myocardial Perfusion Scintigraphy with Thallium

Echocardiography

Exercise Echocardiography

Computed coronary tomography angiography(CCTA)

Positron Emission Tomography

Ambulatory ST Segment Monitoring

Electron Beam Tomography

Cardiac Magnetic Resonance Imaging

Coronary Angiography

Treatment

Medical Therapy

Revascularization

PCI
CABG
Hybrid Coronary Revascularization

Alternative Therapies for Refractory Angina

Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

Discharge Care

Patient Follow-Up
Rehabilitation

Secondary Prevention

Guidelines for Asymptomatic Patients

Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients

Landmark Trials

Case Studies

Case #1

Chronic stable angina 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 Chronic stable angina rehabilitation

CDC onChronic stable angina rehabilitation

Chronic stable angina rehabilitation in the news

Blogs on Chronic stable angina rehabilitation

to Hospitals Treating Chronic stable angina rehabilitation

Risk calculators and risk factors for Chronic stable angina rehabilitation

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

Template:WikiDoc Sources