CARDIAC REHABILITATION

Cardiovascular disease is responsible for a third of deaths globally, with 7.4 million deaths by coronary heart disease (CHD) in 2012 (WHO 2012). Although the mortality rate for CHD has decreased in the United Kingdom mainly due to a decrease in risk factors, particularly smoking, it has decreased less than in many other developed countries (Peterssen 2005) (Anderson 2014).

In 1993, the World Health Organisation (WHO) defined Cardiac Rehabilitation as the coordinated sum of interventions required to favourably influence the disease, ensuring the best physical, psychological and social conditions so that the patients can, by their own means, retain or resume their activities in society in the optimum way. Rehabilitation should not be considered an isolated therapy. It should be integrated into the overall treatment of heart disease, which is one more facet.

Benefits of Cardiac Rehabilitation

  • Improves tolerance for exercise
  • Reduces symptomatology
  • Increases muscle strength
  • Increases the habit of exercising
  • Helps, along with other means, to reduce risk factors
  • Restores physiological state
  • Increases the rate of reemployment
  • Reduces morbidity (complications)
  • Prolongs life expectancy
  • Mitigates new cardiovascular events

(Balraj S, y cols. Cochrane 2011; Issue 7) (Agency for Health Care Policy and Research, 2000)  

There is sufficient scientific evidence in favour of the efficiency of cardiac rehabilitation (CR) programmes with a significant improvement in the patient’s quality of life, capacity for exercise, lipid profile, body mass index, weight, blood pressure, resting heart rate, survival, and decrease of risk factors for myocardial infarction. It is also associated with a decrease in anxiety and depression.

Patients who benefit early from entering CR programmes improve their participation and adherence to treatment, ensuring early intervention on risk factors, as well as reducing short-term morbidity and mortality as well as the reported late mortality of 20-32% (Collins 2014, citation 3)

Indications of Cardiac Rehabilitation

  • Acute myocardial infarction
  • Stable effort angina
  • Heart surgery
  • Coronary angioplasty (with or without stent)
  • Chronic heart failure
  • Cardiomyopathies
  • People with cardiovascular risk factors
  • Prevention in healthy people with risk factors for cardiovascular disease and in family members of people with atherosclerosis

Cardiac Rehabilitation Programmes

This intervention may include exercises, training on risk factors, changes in behaviour, psychological support and strategies aimed at controlling traditional risk factors for cardiovascular disease. Cardiac rehabilitation is a fundamental part of contemporary attention to heart disease and is considered a priority in countries with a high prevalence of CC. International clinical guides consistently identify exercise as a key element in cardiac rehabilitation (Balady 2007; Graham 2007; NICE 2007).

Long-term cardiac rehabilitation (that is, 12 or more months of monitoring) is safe and effective in reducing global and cardiovascular mortality, and reducing the risk of shorter hospital admissions in clinically stable patients (< 12 months of monitoring) in patients with CC (Anderson, Taylor. Cochrane Database of Systematic Reviews 2014 Issue 12)

CR is oriented in 3 phases or areas that are described below:

Phase I

– Hospitalised patients

– Early mobilisation

– Duration dependent on time of admission, if there have been complications…

Phase II

– Outpatient regime

– Professional supervision

Phase III

– Sports centres

– No professional supervision

– Medical and nursing examinations

– Duration: entire life

Conclusion

CR carried out in specialised multidisciplinary units is safe and effective in the treatment of stable patients following acute myocardial infarction, percutaneous coronary intervention or heart failure: it reduces total cardiovascular mortality and hospital admissions, and restores the health of patients with heart disease.

Ultimately, cardiac rehabilitation seeks to restore the health of patients with heart disease and improve their quality of life.

Bibliography

  1. Cassandra L COLLINS, Neville SUSKIN, Sandeep AGGARWAL, Sherry L GRACE. Cardiac rehabilitation wait times and relation to patient outcomes. Eur J Phys Rehabil Med 2014 Sep 12.
  2. Anderson L1, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014 Dec 12;12:CD011273. doi: 10.1002/14651858.CD011273.pub2.
  3. Agency for Health Care Policy and Research, 2000
  4. Balraj S, y cols. Cochrane 2011; Issue 7
  5. Balady 2007
  6. Graham 2007
  7. NICE 2007
  8. Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. American Association of Cardiovascular and Pulmonary Rehabilitation/American College of Cardiology/American Heart Association Cardiac Rehabilitation/Secondary Prevention Performance Measures Writing Committee. Circulation. 2007 Oct 2;116(14):1611-42. Epub 2007 Sep 20.
  9. McMurray JJ, y cols. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC European Heart Journal (2012) 33, 1787–1847

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