II. Background
- Cardiac Rehabilitation is under-utilized by Medicare-eligible indications (only 14-31% participation)
- Cardiac Rehabilitation has great efficacy as a secondary prevention tool
III. Indications
-
Medicare reimbursed indications (3 sesssions per week for 3 months)
- Following acute Myocardial Infarction (STEMI or non-STEMI) in the last 12 months
- Status-post Coronary Artery Bypass Graft (CABG)
- Status-post Percutaneous Coronary Intervention (PCI)
- Stable Angina Pectoris
- Status-post Vascular Surgery
- Status-post Heart Transplantation
- Status-post Heart Valve Repair or Replacement
- Recent CVA (women only)
- Other indications
- Stable Congestive Heart Failure with reduced left-ventricular ejection fraction
- Peripheral Arterial Disease
- Status-post Ventricular Assist Device placement
- Pacemaker or Implantable Cardioverter-Defibrillator
IV. Protocol: Cardiac Rehabilitation Phases
-
General
- Standard programs
- Intensive programs (limited availability)
- Intensive programs may include up to 72 sessions over up to 18 weeks
- Medicare approved programs
- Dean Ornish Program for Reversing Heart Disease
- Pritikin Intensive Cardiac Rehab Program
- Benson-Henry Institute Cardiac Wellness Program
- Phase I Cardiac Rehabilitation (during hospitalization for acute event or procedure)
- Supervised, structured early Physical Activity
- Patient Education
- Risk stratification (low level, graded, Exercise tolerance testing)
- Phase II Cardiac Rehabilitation (Early Outpatient)
- Supervised Physical Activity program
- Reassess symptom-limited Exercise tolerance
- Custom tailored Exercise Prescription for 30 minutes daily and 5 days weekly
- Monitoring of Blood Pressure, pulse, cardiac rhythm
- Maintain Blood Pressure <140/90 mmHg
- Nutrition counseling
- May involve education on cooking and grocery shopping
- Diabetes Mellitus Type II control with Hemoglobin A1C <8%
- LDL Cholesterol <100 mg/dl (preferable <70 mg/dl)
- Body Mass Index reduction towards goal of <27 kg/m2 (ideally <25 kg/m2)
- Cardiac Risk Factor modification
- Reassess cardiac symptoms at rest and with activity
- Psychosocial support to screen for and manage Major Depression
- Supervised Physical Activity program
- Phase III Cardiac Rehabilitation (Late Outpatient)
- Maintain and reinforce phase I and II management
- Reinforce medication use, Patient Education
V. Protocol: Activity restrictions following acute Myocardial Infarction
- Gradually increase activity over 6-8 weeks following MI
- Return to work by 8 weeks after MI
- Activity program may start by 3-4 weeks after MI
- Sexual activity restarted at 4-6 weeks after MI
- See Sexual Intercourse after Myocardial Infarction
VI. Protocol: Other Measures
- Influenza Vaccine each year
VII. Efficacy
- Reduced Angina, Dyspnea, and Fatigue
- Reduced Major Depression after acute coronary event
- Exercise performance improved
- Activities of Daily Living (ADL) performance improved
- Quality of life improved
- Decreased re-hospitalization rate
- Decreased work absence
- Reduced age-adjusted cardiovascular mortality by 50%
- References
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MEDLINEPLUS) |
Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include
These symptoms can sometimes be different in women. What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat - called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI_FDA) | Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. |
| Definition (NCI_CTCAE) | A disorder characterized by gross necrosis of the myocardium; this is due to an interruption of blood supply to the area. |
| Definition (NCI) | Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. |
| Definition (CSP) | gross necrosis of the myocardium, as a result of interruption of the blood supply to the area. |
| Definition (MSH) | NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D009203 |
| ICD10 | I22 , I21 |
| SnomedCT | 66514008, 266288001, 155304006, 194796000, 233824008, 22298006 |
| LNC | LP98884-7, MTHU035551, LA14274-7, LA10558-7 |
| English | Myocardial Infarct, Infarctions, Myocardial, Myocardial Infarction, Myocardial Infarctions, Infarcts, Myocardial, Myocardial Infarcts, HEART ATTACK, Infarct, Myocardial, Infarction, Myocardial, MI, Myocardial infarction (MI), Attack heart (NOS), Infarct myocardial, cardiac infarction, Myocardial Infarction [Disease/Finding], attacking heart, heart attacks, attack hearts, infarctions myocardial, infarcts myocardial, myocardial infarctions, Infarction;heart, myocardial infarcts, Infarction;myocardial, AMI, attacks coronary, attacks hearts, coronary attack, disorder infarction myocardial, myocardial necrosis, syndrome myocardial infarction, heart attack, mies, Heart Attack, Attack - heart, Cardiac infarct, myocardial infarction, myocardial infarction (diagnosis), MI, MYOCARDIAL INFARCTION, MYOCARDIAL INFARCTION, MYOCARDIAL INFARCTION, (MI), INFARCTION (MI), MYOCARDIAL, -- Heart Attack, Cardiovascular Stroke, Cardiovascular Strokes, Stroke, Cardiovascular, Strokes, Cardiovascular, Myocardial infarct, Myocardial infarction, Heart attack, MI - Myocardial infarction, Cardiac infarction, Infarction of heart, Myocardial infarction (disorder), cardiac; infarction, infarction; myocardial, Cardiac infarction, NOS, Heart attack, NOS, Infarction of heart, NOS, Myocardial infarction, NOS, Heart Attacks, Infarctions (Myocardial), Myocardial infarction NOS, Attack coronary, heart infarction |
| German | MYOKARDINFARKT, Koronarattacke, Herzanfall, MI, Herzanfall (NNB), HERZANFALL, Herzinfarkt, Myokardinfarkt |
| Dutch | hartaanval, hartinfarct, hartaanval (NAO), MI, cardiaal; infarct, infarct; myocard, myocardinfarct, Hartinfarct, Infarct, myocard-, Myocardinfarct |
| French | Crise coronaire, IM, Crise cardiaque SAI, Crise cardiaque, CRISE CARDIAQUE, INFARCTUS DU MYOCARDE, IDM (Infarctus Du Myocarde), Infarctus du myocarde, Infarctus myocardique |
| Italian | MI, Attacco cardiaco, Attacco coronarico, Attacco cardiaco (NAS), Infarto del miocardio, Infarto miocardico |
| Portuguese | Ataque coronário, Ataque do coração, Ataque cardíaco NE, EM, ATAQUE CARDIACO, ENFARTO DO MIOCARDIO, Enfarte do miocárdio, Infarto do Miocárdio |
| Spanish | IM, Crisis coronaria, Ataque al corazón, Ataque al corazón (NEOM), Infarto miocárdico, ATAQUE CARDIACO, INFARTO DE MIOCARDIO, Infarto al Miocardio, ataque al corazón, infarto cardíaco, infarto de corazón, infarto de miocardio (trastorno), infarto de miocardio, Infarto de miocardio, Infarto del Miocardio |
| Japanese | 心臓発作（ＮＯＳ）, 冠発作, 心臓発作, ｶﾝﾎｯｻ, ｼﾝｿﾞｳﾎｯｻNOS, ｼﾝｿﾞｳﾎｯｻ, ｼﾝｷﾝｺｳｿｸ, 冠状動脈梗塞, 心筋梗塞, 冠動脈梗塞, 心筋梗塞症 |
| Swedish | Hjärtinfarkt |
| Czech | infarkt myokardu, Srdeční záchvat, Srdeční záchvat (NOS), IM, Koronární záchvat, Infarkt myokardu |
| Finnish | Sydäninfarkti |
| Russian | INFARKT MIOKARDA, ИНФАРКТ МИОКАРДА |
| Croatian | SRČANI INFARKT |
| Polish | Świeży zawał serca, Zawał serca świeży, Zawał mięśnia sercowego, Zawał serca |
| Hungarian | Coronaria roham, Szívroham (k.m.n.), Szívroham, Infarctus myocardii, Szívizom infarctus, MI |
| Norwegian | Hjerteinfarkt, Hjerteattakk, Myokardinfarkt |
Ontology: Cardiac rehabilitation (C0700431)
| Definition (CCC) | Actions performed to restore cardiac health |
| Definition (MEDLINEPLUS) |
Cardiac rehabilitation (rehab) is a medically supervised program to help people who have
The goal is to help you return to an active life, and to reduce the risk of further heart problems. A team of specialists will create a plan for you that includes exercise training, education on heart healthy living, and counseling. You will learn how to reduce your risk factors. These may include disorders such as high blood pressure, high blood cholesterol, overweight or obesity, diabetes. Smoking, lack of physical activity, and depression are other risk factors. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI) | A medically supervised program to improve the health and well-being of people who have heart problems. This may include exercise training, education on heart healthy living, and/or counseling to reduce stress. (ACC) |
| Definition (NCI_CDISC) | A medically supervised program to improve the health and well-being of people who have heart problems. This may include exercise training, education on heart healthy living, and/or counseling to reduce stress. |
| Definition (NIC) | Promotion of maximum functional activity level for a patient who has experienced an episode of impaired cardiac function that resulted from an imbalance between myocardial oxygen supply and demand |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 183378000, 151613007, 313395003 |
| LNC | LP29869-2, MTHU013092 |
| English | Cardiac rehabilitation, Cardiac Care: Rehabilitative, cardiac rehabilitation, cardiac rehabilitation (treatment), rnrx cardiac rehabilitation (treatment), rnrx cardiac rehabilitation, rnox provide cardiac rehabilitation therapy, rnox provide cardiac rehabilitation therapy (treatment), Cardiac rehabilitation treatment, rehabilitation cardiac, cardiac rehabilitation therapy, therapy cardiac rehabilitation, cardiac rehabilitation treatments, Cardiac rehabilitation therapy, Cardiac Rehabilitation, Heart Diseases--Rehabilitation, Cardiac care: rehabilitative, Cardiac rehabilitation (regime/therapy), Cardiac rehabilitation (procedure) |
| Italian | Terapia di riabilitazione cardiaca |
| Japanese | 心リハビリテーション療法, ｼﾝﾘﾊﾋﾞﾘﾃｰｼｮﾝﾘｮｳﾎｳ |
| Czech | Rehabilitace při onemocnění srdce |
| Hungarian | Cardialis rehabilitációs kezelés |
| Spanish | rehabilitación cardíaca (procedimiento), rehabilitación cardíaca (régimen/tratamiento), rehabilitación cardíaca, Terapia de rehabilitación cardiaca |
| Portuguese | Terapia de reabilitação cardíaca |
| Dutch | hartrehabilitatietherapie |
| French | Réadaptation fonctionnelle cardiaque |
| German | Herzrehabilitationstherapie |
