1. What to Expect from your Student Practicum Experience
Cardiac Rehabilitation
Deborah Sullivan MS, ANP-BC
Cardiovascular Prevention and Rehabilitation Department
Lahey Clinic Medical Center
41 Mall Road
Burlington, MA 01805
.org

2. Cardiac Rehabilitation
What is Cardiac Rehabilitation
Medically supervised program
Optimize a cardiac patient’s
physical
psychological
social functioning
stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes
reducing death and disability AACVPR.org
Requires a physician referral and regular communication regarding the patients individual treatment plan

3. Patient Population Myocardial infarction (heart attack)
Coronary artery bypass graft surgery (CABG)
Current stable angina pectoris
Heart valve repair or replacement
Percutaneous transluminal coronary angioplasty (PTCA)/ or coronary stenting
Heart or heart-lung transplant
___________________________________________________
Heart Failure and those with ventricular assist devices
Coronary artery disease equivalents such as diabetes or peripheral artery disease
Patients with diabetes
Peripheral arterial disease
The following is a list of patient population groups that benefit from cardiac rehabilitation. Medicare covers the first 6 patient groups

4. Components of Cardiac Rehabilitation
Cardiac rehabilitation is tailored to meet the patient’s individual needs and goals. 
Utilizes a multidisciplinary team
The Centers for Medicare and Medicaid Services (CMS) defines core components :
Prescribed exercise
Cardiac risk factor modification
Psychosocial Assessment
Medical Nutrition Therapy
Outcomes Assessment
ITP (Individual Treatment Plan)
An Individualized Treatment Plan (ITP) is also a required element that describes the individual’s diagnosis, the type, amount, frequency and duration of the items and services under the plan and the goals set for the individual under the plan.  The plan is written, established, reviewed, and signed by a physician every 30 days.

5. Cardiac Rehabilitation
Three phases
Phase I: during hospitalization,
Phase II: a supervised ambulatory outpatient program lasting 3-6 months,
2-4 weeks post event
Adjustment period
Telemetry monitored
Phase III: lifetime maintenance stage

6. Typical day at the facility
No such thing as a typical day!!
Treat your practicum like a job
Choose the cardiac rehab setting because you want to be there!!
Dress appropriately, be on time, be prepared, be well rested, stay home if your sick
You will need your own stethoscope on your first day of your clinical experience (Littmann stethoscope is about $70.00)
Hospital orientation, confidentiality statement, orientation check list

7. Typical day at the facility
Fast paced environment, multi-tasking
Monday, Wednesday, Friday
Early start at 7AM
Exercise classes run until about 6-7PM
Formal Education –monthly symposium
Team meeting
Tuesday, Thursday
Phase II or III programs

8. Shadow a patient Entrance evaluation
Review the patients information/discharge summary (medical jargon)
History
Physical assessment
Lab results
Procedures
Diagnostic Tests (i.e. echo, cardiac cath, x-ray, PFTs)
Musculoskeletal assessment

9. Shadow a patient Entrance Evaluation (at Lahey) Pharmacist Nurse
Social Worker
Dietician
Exercise Tolerance Test

10. Principals of Exercise Physiology
METs
Calculation of max (ETT) and sub max METs
Patient education
Design the patients exercise prescription
Karvonen reserve formula based on the results of the ETT and MET level achieved (establish a THR)
ACSM guidelines
Borg Scale
Patient considerations

11. Borg Scale of Rate of Perceived Exertion6
7 very, very light 8
9 very light 10
11 fairly light 12
13 somewhat hard 14
15 hard 16
17 very hard 18
19 very, very hard 20

12. Additional Tasks Data entry to evaluate outcomes
Assist with establishing plans of care
Interactions with patients
Education (shoes, hydration, environmental factors, etc.)
Exercise leadership (free weights/resistance training)
Stretching and relaxation

13. Your responsibility during the rehab session
Be familiar with emergency equipment and plan
Prescreening prior to beginning exercise; Assess for pain or discomfort (0-10 scale)
Check resting blood pressure, heart rate and rhythm
Guidance on warm-up exercises, proper body mechanics, safety precautions
Assist patients on exercise equipment, obtain exercise BP, HR, RPE, watts, METs, time, symptoms
Document information, communicate with team

14. Review rhythm strip Know how to diagnose normal sinus rhythm

15. Pharmacology Commonly used medications in cardiac rehab patients
Beta Blockers
Calcium Channel blockers
Statins
Nitrates
Diuretics
ACE Inhibitors/ARBS
Anti-platelets

16. Bring your area of interest to your practicum and expand on it
Fish Oil Supplements & Benefits of Omega-3 Fatty Acids
By Timothy Duffy, UMass Lowell Exercise Physiology Student
The Importance of Resistance Training in Cardiac and Pulmonary Rehabilitation Settings
By Erin Foley, Student , UMass Lowell Exercise Physiology
Published in the MACVPR Newsletter (macvpr.org)

17. Resources Thank you!! macvpr.org aacvpr.org pcna.net
Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, 4th Edition
Cardiac Resource Manual
Guidelines for Pulmonary Rehabilitation Programs, 4th Edition
ACSM's Guidelines for Exercise Testing and Prescription, Eighth Edition
macvpr.org
aacvpr.org
pcna.net
Thank you!!