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Cardiac Rehab. 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. Cardiac Rehab Phases. - PowerPoint PPT Presentation
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Cardiac RehabCardiac Rehab
Cardiac Rehab defined:Cardiac Rehab defined:A progressive A progressive program with a program with a goal of helping goal of helping patients restore patients restore and maintain and maintain optimal health optimal health while helping to while helping to reduce the risk of reduce the risk of future heart future heart problems.problems.
Cardiac Rehab PhasesCardiac Rehab PhasesPhase I- (inpatient) assessment and Phase I- (inpatient) assessment and mobilization, education on risk mobilization, education on risk factors and a discharge planfactors and a discharge planPhase II- (outpatient) exercise, risk Phase II- (outpatient) exercise, risk factor reduction, reduce factor reduction, reduce morbidity/mortality, improve function morbidity/mortality, improve function and quality of life and build and quality of life and build confidenceconfidencePhase III&IV- maintenance programPhase III&IV- maintenance program
StaffingStaffingMedical Director- MDMedical Director- MD– Available for consultAvailable for consult– Assist in program developmentAssist in program development– Approve all policies/proceduresApprove all policies/procedures– Be involved in therapeutic aspects of Be involved in therapeutic aspects of
programprogram
Coordinator- RN, Ex. Phys, RD, MBACoordinator- RN, Ex. Phys, RD, MBA– Administrative dutiesAdministrative duties– Direct patient careDirect patient care
StaffingStaffingRegistered Nurse (RN)-Registered Nurse (RN)-– LicensedLicensed– ACLS trainedACLS trained– Cardiovascular experienceCardiovascular experience
Exercise Physiologists-Exercise Physiologists-– Bachelor’s degreeBachelor’s degree– Master’s degree (preferred/required)Master’s degree (preferred/required)– ACLS trainedACLS trained– ACSM certification (preferred)ACSM certification (preferred)– ExperienceExperience
StaffingStaffing
Registered Dietitian (RD)-Registered Dietitian (RD)-– ADA registeredADA registered– Master’s degree (preferred)Master’s degree (preferred)– ExperienceExperience
Others-Others-– Administrative Assistants, Health Administrative Assistants, Health
educator, Certified Diabetes Educator, educator, Certified Diabetes Educator, Mental Health Prof., P.T., O.T., Mental Health Prof., P.T., O.T., PharmacistPharmacist
Exercise Physiologist’s role:Exercise Physiologist’s role:Inpatient visits Inpatient visits (recruiting)(recruiting)
Conduct Conduct orientations & orientations & assessmentsassessments
Individualize Individualize exercise exercise prescriptionsprescriptions
Manage classesManage classes
Monitor HR/BP/ECG Monitor HR/BP/ECG response to exer. & response to exer. & other other signs/symptomssigns/symptoms
Teach education Teach education classesclasses
Counseling Counseling
Discharge planningDischarge planning
Typical ClassTypical Class
At least 4:1 patient/staff ratioAt least 4:1 patient/staff ratio
Hook up, 10 min. warm-up, 45 Hook up, 10 min. warm-up, 45 minutes cardiovascular training, 10 minutes cardiovascular training, 10 minutes cool downminutes cool down
Education classesEducation classes
FacilityFacility
RehabRehab
Education ClassesEducation Classes
Nutrition- RDNutrition- RD
Medications- PharmacistMedications- Pharmacist
Cholesterol, Hypertension, Anatomy Cholesterol, Hypertension, Anatomy & Physiology, Stress, Weight Control, & Physiology, Stress, Weight Control, Exercise & Your Heart, CAD, Alcohol- Exercise & Your Heart, CAD, Alcohol-Caffeine-TobaccoCaffeine-Tobacco
ChallengesChallengesPhysician supportPhysician supportInsurance requirements!Insurance requirements!Medicare will only cover:Medicare will only cover:– MIMI– CABGCABG– Stable AnginaStable Angina
Most managed care providers will Most managed care providers will cover a majority if not all of rehabcover a majority if not all of rehab
““Ideal” PatientIdeal” Patient
57 yo, MI, PTCA/stent 57 yo, MI, PTCA/stent
Completed 36 sessions of Phase II Completed 36 sessions of Phase II cardiac rehabcardiac rehab
Lost 13 poundsLost 13 pounds
Significantly increased workloadsSignificantly increased workloads
Tolerated exercise well w/ no Tolerated exercise well w/ no cardiovascular complaintscardiovascular complaints
Success StorySuccess Story
71 yo male71 yo male
CABGx3 & other significant heart hxCABGx3 & other significant heart hx
Presented w/ an unusual EKGPresented w/ an unusual EKG
Patient was admitted to hospital and Patient was admitted to hospital and received a defibrillator received a defibrillator
““Repeat Offender”Repeat Offender”
60 yo male60 yo male
Med. History-CABG 1979 & 1990Med. History-CABG 1979 & 1990
PTCA/stents- 96,97,03,04 & 05PTCA/stents- 96,97,03,04 & 05
Risk Factors= Family Hx, Stress, Risk Factors= Family Hx, Stress, Cholesterol Cholesterol
??????
Typical ProblemsTypical Problems
73 yo male73 yo male
MI, Hx of CABGMI, Hx of CABG
Blood Pressures= 184/80, 178/78, Blood Pressures= 184/80, 178/78, 170/68, etc170/68, etc
Physician keeps changing medsPhysician keeps changing meds
??????
OutcomesOutcomes
Data collected on 217 PHD patients:Data collected on 217 PHD patients:– 16.2% change in LDL cholesterol16.2% change in LDL cholesterol– 11.3% change in triglycerides11.3% change in triglycerides– 6% change in obesity6% change in obesity
Psychosocial Factors:Psychosocial Factors:
Participants who rate their health as:Participants who rate their health as:
PrePre PostPost
Excellent Excellent 8.1% 7.8%8.1% 7.8%
Very GoodVery Good 17.2 17.2 31.231.2
GoodGood 45.945.9 44.944.9
FairFair 22.522.5 14.614.6
PoorPoor 6.26.2 1.51.5
ResourcesResourcesNorth Texas Association of Cardiovascular North Texas Association of Cardiovascular and Pulmonary Rehab (NTACVPR)and Pulmonary Rehab (NTACVPR)– Meetings 2Meetings 2ndnd Tuesday of every other month- Tuesday of every other month-
Nov. 8Nov. 8thth- Presby Plano 6:30- Presby Plano 6:30– tacvpr.orgtacvpr.org
AACVPR.orgAACVPR.org
Presbyterian Hospital of Dallas- Presbyterian Hospital of Dallas-
214-345-6375 214-345-6375
Internship opportunitiesInternship opportunities