Cardiac Rehabilitation

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Condition: The goal of cardiac rehabilitation is to restore and improve function, limit disability, minimize risk factors, and optimize cardiac conditioning through exercise and education specific to patients with heart disease.

Background: Cardiovascular disease is the leading cause of death and disability in the United States. Cardiac rehabilitation is underutilized in the United States, with an estimated participation of only 10-20% of eligible patients.

Risk Factors: Risk factors for developing cardiac disease include increased age, male gender, history of vascular disease, and family history as well as reversible factors, such as diabetes, high blood pressure, high cholesterol levels, obesity, smoking, stress, and diet. Women and lower income patients are significantly less likely to be referred for cardiac rehabilitation, and Hispanic and black patients are less likely to be referred than whites. The unemployed, widowed, and arthritis patients are less likely to participate in successful rehabilitation.

History and Symptoms: Often patients with cardiac disease have other problems including impaired lung function, limiting their mobility and exercise ability. Depending on the specific heart condition, the patient may present with difficulty breathing, shortness of breath, swelling, night waking, fatigue, fainting, chest pain, heart palpitations, dizziness, or pain in the legs during exercise due to circulation problems.

Physical Exam: Physical examination includes determination of heart rate, swelling, and heart sounds as well as assessment of breathing.

Diagnostic Process: Physicians will use tests for cholesterol levels, diabetes, and kidney disease. Electrocardiogram helps to identify structure/blockages and rhythm problems of the heart. Chest x-rays may be useful, and echocardiogram (ECG) can be performed. Cardiac stress testing is used to evaluate tolerance to exercise. Other visualization tests, such as MRI, can also be used depending on disease symptoms.

Rehab Management: Early rehabilitation involves walking and exercise with cardiac monitoring. Then, outpatient cardiac rehabilitation, which consists of 3 supervised sessions per week for up to 8 weeks, requires coordinated care with the patient, cardiologist, pulmonologist, rehabilitation physician, physical therapists, occupational therapists, social workers, and a nutritionist to ensure lifelong rehabilitation, which involves an active lifestyle, a healthy diet, and adherence to medication. Successful treatment decreases symptoms of heart failure, lowers cholesterol levels, reduces stress, and ultimately decreases death.

Other Resources for Patients and Families: The American Heart Association and the American Association of Cardiopulmonary Rehabilitation are sources of support and have outlined cardiac rehabilitation programs. Patients and family members should receive instruction about healthy diets, monitoring of blood pressure and blood sugar levels, and recognition of heart disease symptoms. Letters, telephone calls, and home visits can help motivate patients to adhere to cardiac rehabilitation programs.



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