Cardiac Rehabilitation Deborah Sullivan MS, ANP-BC Cardiovascular Prevention and Rehabilitation...

Cardiac RehabilitationDeborah Sullivan MS, ANP-BCCardiovascular Prevention and Rehabilitation DepartmentLahey Clinic Medical Center41 Mall RoadBurlington, MA 01805Deborah.sullivan@lahey .org781 744-2460

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

• 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

• 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)

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

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

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

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

Entrance Evaluation (at Lahey) Pharmacist Nurse Social Worker Dietician Exercise Tolerance Test

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

6 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

Data entry to evaluate outcomesAssist with establishing plans of care Interactions with patients

Education (shoes, hydration, environmental factors, etc.)

Exercise leadership (free weights/resistance training)

Stretching and relaxation

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

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

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)

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.orgaacvpr.orgpcna.net

Thank you!!