Cardiac Rehabilitation - The Four Phases
CARDIAC REHABILITATION WITHIN D&WF CHP
Cardiac rehabilitation (CR) is an active process that takes place after a person has a heart attack or other heart treatments e.g. surgery or angioplasty with stenting. The aim is to restore a person to, and maintain him or her at, a best possible level of physical and mental well being. It requires people to assume responsibility for their own health and well being, and to realise their potential to lead an active life. There are four phases to CR.
This phase occurs when a person is an inpatient at hospital.
Many issues are considered during this phase. These include reassurance, risk factor assessment and modification, education for the patient and his/her family and discharge planning.
A CR Nurse will spend time with the patient and their family. This is usually spread over the duration of the hospital stay. The patient will be asked about what they think caused their cardiac event to discover the patients knowledge base and misconceptions. Also discussed are the disease process, the patients individual risk factors, medication, chest pain management and employment. Apart from verbal communication, a video and leaflets are used. If a patient has had a heart attack, the Heart Manual or the hospitals own package will be given.
The Heart Manual is a 6-week Rehabilitation Programme for patients recovering from a MI.
It consists of a workbook, in six weekly sections and includes a phased programme of health education, home based exercises and stress management. A CD is also provided and contains a programme of relaxation exercises, a scripted interview between a doctor and a patient, and a talk by a doctor targeted at the patients partner or family.
It has been shown, in major clinical trials that patients using the Heart Manual have improved psychological adjustment at one year
Fewer readmissions to hospital within the first 6 months
Less contact with their GPs in the first year.
Those patients who were clinically anxious or depressed on discharge from hospital showed reductions in anxiety and depression compared to control group patients.
Patients who are not suitable for the Heart Manual e.g. patients who are physically unable to exercise or those with severe heart failure, receive the hospitals own package. Families are involved as much as possible.
Prior to discharge the patient will be informed of when they will be sent for to attend hospital for a cardiology review. He/she will also be informed of the Primary Care staff involvement at home and be given a contact number for the Rehabilitation Team.
This is the early post discharge phase. Members of the Primary Care Team based in General Practice and who are trained as Heart Manual Facilitators, provide support during this phase. They visit the patient and their family at home on several occasions, reinforce lifestyle risk factors, monitor anxiety and depression levels and generally support the patient and their family. This support continues for approximately 3 months.
This programme usually starts 6-8 weeks after a heart attack or 12 weeks after cardiac surgery or other intervention and lasts for 12 weeks, however if the patients needs more support then they may remain in Phase 3 for longer.
Phase 3 takes the form of a structured exercise programme with educational and psychological support, and advice on risk factors. It is tailored to suit individual needs. The CR Nurses co-ordinate the programme and the British Association for Cardiac Rehabilitation (BACR) trained fitness instructor provides the exercise part of the programme.
This phase has two main components
Long term maintenance with advice on lifestyle and risk factors including management of BP, cholesterol, glucose etc and drug therapy. A structured exercise programme in conjunction with the local community run Leisure Centre is provided. This is to help encourage patients to maintain their new life-style changes, improve fitness, and to promote exercise on a regular basis. Again Phase 4 is co-ordinated by a CR Nurse and the exercise part is led by a BACR fitness instructor.
Monitoring of long-term maintenance is where Primary Care Practitioners are most needed. The issues to be considered include identifying and discussing cardiac misconceptions, giving positive reinforcement to maintain a healthy lifestyle and general screening in a structured manner. Referral and recall systems should be in place to ensure optimum care is given.