Don't count your heart out
By Jacob Sitzmann, RCEP, Cardiac Rehabilitation Coordinator
For 20 years, comprehensive exercise-based cardiac rehabilitation has been linked with a lower risk of death from heart disease. The overwhelming evidence shows comprehensive cardiac rehabilitation programs as best practice for patients with cardiovascular disease. Cardiac rehabilitation can improve quality of life, increase maximal exercise capacity and oxygen uptake, improve endothelial function, decrease mortality and morbidity, decrease bad cholesterol, and improve blood pressure and blood sugar control.
At Bartlett Regional Hospital, we want to help patients make the right decisions and feel better about themselves by improving risk factors and prolonging life. It's a team effort between the patient, staff, and physician. We collaborate with their physician if problems arise, such as medication adjustments, abnormal findings, or the appearance of disease symptoms.
Life following a major cardiovascular event can be complicated. A heart attack can impact much more than a person's heart. It can have profound effects on mood and attitude, sense of certainty about the future, confidence in ability to perform duties at work and/or home, and even cause feelings of embarrassment. Often, the most challenging aspect of this job is helping patients understand that these feelings are very common, and it will take time to feel “normal” again. Building patient confidence is rewarding for both the patient and their clinical exercise physiologist.
At Bartlett we follow guidelines established by the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Sports Medicine.
Prior to starting their rehab course, patients are assessed according to the following core components:
A risk profile is established for each patient. This includes reviewing the patient's risk factors, comorbidities, medications and medical history.
Patients entering cardiac rehab typically perform some form of exercise or questionnaire which helps estimate their functional capacity. This could include a stress test, a hall walk, or an activity scoring index. An individual exercise prescription is provided based on their results. Each patient wears a heart monitor to observe their electrocardiogram during exercise for any disturbances. The program is modified throughout the course of care.
A nutritional assessment helps patients understand the effect of food on their health and modify their diet for healthy food choices. This is often the most challenging core component. Patients can be referred to a dietitian for individual counseling. The Mediterranean Diet is the go-to dietary plan for managing coronary artery disease.
Depression, anxiety and denial can occur in up to 20% of patients. Questionnaires assess patients for depression and anxiety. Potential interventions from a primary care physician may include medications and/or referral to counseling.
Blood pressure assessment
Blood pressure is checked frequently throughout the rehab course. Abnormal readings are passed on to the referring physician. Revisions in blood pressure medications or dosages are common during a patient's rehab course.
High cholesterol has the highest percentage of attributable risk post myocardial infarction. The guidelines on lipid management are constantly changing. Generally, the goal for patients with ischemic coronary disease is to be on high-intensity statin therapy.
A quarter of patients referred to cardiac rehab have diabetes. Depending on the type of diabetes, pre- and post-exercise blood sugars are checked daily to identify response to exercise. Patients may meet with our diabetes educator.
While often the most challenging, smoking cessation is the most important and cost effective of all lifestyle modifications. Mortality can decrease by up to 50% in the first two years in people who quit smoking. Smokers are counseled on cessation and/or can be given medications to help them quit with clearance from their physician.
Physical activity counseling
Physical activity outside of cardiac rehab can have many of the same benefits: weight loss, reduction in blood pressure and improved lipids. Most guidelines recommend 30 to 60 minutes of moderate activity most days of the week. Guidelines for home exercise are provided to each patient. We strive for the best patient outcomes possible. In 2019, 68% of our patients who completed their prescribed course of cardiac rehab improved their functional capacity. Patients also saw an average increase of 74% of activity minutes per week.
A completed cardiac rehabilitation course can have profound effects on patient overall well-being. Our staff does everything possible to customize and accommodate your experience to make it the best it can be in a safe, responsible and well-informed manner. Patients are referred by their primary care providers. We offer cardiac rehab three times per week, on Mondays, Wednesdays and Fridays. We follow COVID-19 protocols and do our best to keep a safe environment.