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]
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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 chief goal is to provide help the patients understand their disease and inculcate a regimen to stablize and reduce or even reverse the progression of cardiovascular disease. Overall, this will reduce adverse cardiac events, morbidity and mortality. 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 getting into trouble. 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:
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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. |
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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]:
- MI/acute coronary syndrome
- CABG
- PCI
- Stable angina
- Heart valve surgical repair or replacement
- Heart or heart/lung transplantation
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]
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Class IComprehensive cardiac rehabilitation program (including exercise). (Level of Evidence: B) |
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Cardiac Rehabilitation in United States
Cardiac Rehabilitation in Europe
Western Europe
Central Europe
Eastern Europe
Cardiac Rehabilitation in Africa
South Africa
Central Africa
North Africa
Cardiac Rehabilitation in Canada
Cardiac Rehabilitation in Australia
Cardiac Rehabilitation in Asia
China
Central Asia
North Asia
Near East
Middle East
Far East
Cardiac Rehabilitation in South America
Back to the work
Who Should go Back to Work?
Patients in Specific Occupations with Chronic Stable Angina
Maintenance of Social Requirements
Pregnancy
Sexual Activities
References
- ↑ Clin Pract Guidel Quick Ref Guide Clin. 1995 Oct;(17):1-23. Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute. Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA, Certo CM, Dattilo AM, Davis D, DeBusk RF, et al. PMID: 8595435
- ↑ 2.0 2.1 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. Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Bonow RO, Estes NA 3rd, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR; AACVPR; ACC; AHA; 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; Society of Thoracic Surgeons. J Am Coll Cardiol. 2007 Oct 2;50(14):1400-33. PMID: 17903645
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. 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. 2003 Jan 7; 107 (1): 149-58. PMID 12515758
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