Cardiac Rehab

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					HERTFORDSHIRE NSF for CHD
      Study Day 2003


 CARDIAC REHABILITATION


       Sharon Hollingworth
           West Herts
•What?


•Why?


•Where?


•Who?


• How?
WHAT?
          CARDIAC REHABILITATION (WHO, 1993)

‘…..the sum of activities required to favourably influence the
underlying cause of the disease, as well as to ensure the
patients the best possible physical, mental and social
conditions so that they may, by their own efforts, preserve, or
resume when lost, as normal a place as possible in the life of
the community. Rehabilitation cannot be regarded as
an isolated form of therapy, but must be integrated with the
whole treatment, of which it forms only one facet’.
INFLUENCES ON CR


•British Association of CR (BACR)
   -guidelines
   -’CR is best practiced by a multidisciplinary team’


•NSF
   -states that ‘CR should be delivered by healthcare
   professionals with a range of skills and should include
   exercise prescription, lifestyle interventions, cognitive
   behavioural therapy and advanced life support’
              STANDARD TWELVE of the NSF


‘NHS trusts should put in place agreed protocols/systems of
care so that, prior to leaving hospital, people admitted to
hospital suffering from CHD have been invited to participate
in a multidisciplinary programme of secondary prevention
and CR. The aim of the programme will be to reduce their
risk of subsequent cardiac problems and to promote their
return to a full and normal life’.
•   Pre-op


•   Phases 1-4:
    1. In-patient

    2. Immediate post-discharge

    3. Outpatients’ rehabilitation
       programme

    4. Long-term maintenance
COMPONENTS INVOLVED


•Education


•Exercise


•Counselling
WHY?
•Reduction in morbidity and mortality
      20-25% <mortality over 3yr follow-up (Oldridge)


•Reduction in Cardiac risk factors


•Psychological benefits


•Improved physical fitness
WHERE?
•Variety of settings
       -church halls
       -patient’s own home
       -gymnasiums
       -OT, physio departments
       -GP practices

•Risk stratification
       -ALS training

•.West Herts
      -SACH Maple therapy (physio gym and OT dept)
      -HHGH Tudor wing
      -WGH lecture room and local gym
WHO?
(1) Patients


•Myocardial infarctions
•PTCAs
•CABGs
•Valve replacements
(2) CHD professionals:


Multidisciplinary team:-

       -cardiologist
       -clerical
       -dietician
       -exercise physiologist
       -nurse
       -OT
       -pharmacist
       -psychologist
Knowledge base required:

•Anatomy and physiology of cardiac function
•Process of cardiovascular disease
•Health psychology
•Theories of adult education
•Theories of motivation and change
•Counselling skills
•Exercise physiology
•Individual exercise prescription
•Management of emergencies
•Nutrition and weight loss
•Audit and evaluation
•Research
•Management and administration
HOW is it done?
•7 week rolling programme

•Two sessions/week

•Each session- 1hr exercise plus 1hr education

•Individual assessment/support

•Discharge assessment
EXERCISE
RELAXATION
EDUCATION


•Anatomy and physiology of CHD
•Medication
•CHD risk factor management
•Stress management
•CHD interventions
•Return to ‘normal’ way of life
DIET

				
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