1. Cardiac Rehab

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

3. Cardiac Rehab Phases Phase I- (inpatient) assessment and mobilization, education on risk factors and a discharge plan Phase II- (outpatient) exercise, risk factor reduction, reduce morbidity/mortality, improve function and quality of life and build confidence Phase III&IV- maintenance program

4. Staffing Medical Director- MD –Available for consult –Assist in program development –Approve all policies/procedures –Be involved in therapeutic aspects of program Coordinator- RN, Ex. Phys, RD, MBA –Administrative duties –Direct patient care

5. Staffing Registered Nurse (RN)- –Licensed –ACLS trained –Cardiovascular experience Exercise Physiologists- –Bachelor’s degree –Master’s degree (preferred/required) –ACLS trained –ACSM certification (preferred) –Experience

6. Staffing Registered Dietitian (RD)- –ADA registered –Master’s degree (preferred) –Experience Others- –Administrative Assistants, Health educator, Certified Diabetes Educator, Mental Health Prof., P.T., O.T., Pharmacist

7. Exercise Physiologist’s role: Inpatient visits (recruiting) Conduct orientations & assessments Individualize exercise prescriptions Manage classes Monitor HR/BP/ECG response to exer. & other signs/symptoms Teach education classes Counseling Discharge planning

8. Typical Class At least 4:1 patient/staff ratio Hook up, 10 min. warm-up, 45 minutes cardiovascular training, 10 minutes cool down Education classes

9. Facility

10. Rehab

12. Education Classes Nutrition- RD Medications- Pharmacist Cholesterol, Hypertension, Anatomy & Physiology, Stress, Weight Control, Exercise & Your Heart, CAD, Alcohol- Caffeine-Tobacco

13. Challenges Physician support Insurance requirements! Medicare will only cover: –MI –CABG –Stable Angina Most managed care providers will cover a majority if not all of rehab

17. “Ideal” Patient 57 yo, MI, PTCA/stent Completed 36 sessions of Phase II cardiac rehab Lost 13 pounds Significantly increased workloads Tolerated exercise well w/ no cardiovascular complaints

18. Success Story 71 yo male CABGx3 & other significant heart hx Presented w/ an unusual EKG Patient was admitted to hospital and received a defibrillator

19. “Repeat Offender” 60 yo male Med. History-CABG 1979 & 1990 PTCA/stents- 96,97,03,04 & 05 Risk Factors= Family Hx, Stress, Cholesterol ???

20. Typical Problems 73 yo male MI, Hx of CABG Blood Pressures= 184/80, 178/78, 170/68, etc Physician keeps changing meds ???

21. Outcomes Data collected on 217 PHD patients: –16.2% change in LDL cholesterol –11.3% change in triglycerides –6% change in obesity

22. Psychosocial Factors: Participants who rate their health as: Pre Post Excellent 8.1% 7.8% Very Good17.2 31.2 Good45.944.9 Fair22.514.6 Poor6.21.5

23. Resources North Texas Association of Cardiovascular and Pulmonary Rehab (NTACVPR) –Meetings 2 nd Tuesday of every other month- Nov. 8 th - Presby Plano 6:30 –tacvpr.org AACVPR.org Presbyterian Hospital of Dallas- 214-345-6375 Internship opportunities