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Introduction
Heart failure is estimated to affect 4 to 5 million Americans, with 550,000 new cases reported annually. In the past 3 decades, both the incidence and prevalence of heart failure have increased. Factors that have contributed to this increase are the aging US population and improved survival rates in patients with cardiovascular disease due to advancements in diagnostic techniques and medical and surgical therapies.
Barriers to Rehabilitation
Lack of Knowledge Poor Motivation Insufficient understanding Lower perceived self-efficacy Forgetfulness, Decrease support from family and other care givers Cost Poor Patient referral by Nurses and Doctors Time conflict between work and rehabilitation program.
Standard Interventions
Cardiac rehab staff nurse will meet patient prior to discharge from hospital and address the rehabilitation program protocol. In accordance with the American College of Sports Medicine guidelines for exercise prescription for rehabilitation ; rehabilitation consists of forty exercise sessions; 24 sessions (3/per week) endurance training on a cycle ergometer ( with 5 minute warm up) 20 min training with constant workload, 5 minute cool down, and 5 min post exercise monitoring. In addition 16, (2/per week) 1 hour sessions of stretching and flexibility exercises.
Research Finding
Mortality rate caused by cardiovascular disease is 8.2% for patients who participate in cardiac rehabilitation program and patients not participating (control group) is 15.3% (Hedback, Perk, Hornblad, Ohlsson, 2001). Percentage of patients who had a recurrent cardiac events was 18.4% in experimental group compared to 34.7% in the control group. (Hedback, Perk, Hornblad, Ohlsson, 2001).
Conclusion
Ensuring patients enrollment into cardiac rehabilitation program post myocardial event and ensuring participation in a rehab program by providing anticipatory guidance, monitoring improvement using measuring tools weekly for the first 6 weeks then monthly for one year, to show improvement in quality of life through increased endurance, return to work, increased self-esteem, and increase social and emotional integration into family life will be an area of research.
References
Marchionni, N., Fattirolli, F., Fumagalli, S., Oldridge, N., Del Lungo, F., Morosi, L., Burgisser, C., & Masotti, G. (2003). Improved exercise tolerance and quality of with cardiac rehabilitation of older patients after myocardial infarction: Result of a random control trial. Journal of the American Heart Association, 107; 2201-2206. Thomas, R. J., Miller, N. H., Lamendola, C., Berra, K., Hedback, B., & Durstine, J. L. (1996). National survey on gender differences in cardiac rehabilitation programs: Patient characteristics and enrollment patterns. Journal of Cardiac Rehabilitation, 16(2) 402-412. Roblin, Douglas PhD; Diseker, Robert A. III MPH; Orenstein, Diane PhD; Wilder, Myrtle CNP, MPH; Eley, Melanie RN. (2004). Delivery of Outpatient Cardiac Rehabilitation in a Managed Care Organization. Journal of Cardiopulmonary Rehabilitation, 24(3), 157-164.
References Con t
Caulin-Glaser, Teresa MD, FACC; Blum, Michael MD, FACC; Schmeizl, Renae RN, BSN, BS; Prigerson, Holly G. PhD; Zaret, Barry MD, FACC; Maxure, Carolyn M. PhD. (2001). Gender Differences in Referral to Cardiac Rehabilitation Programs after Revascularization. Journal of Cardiopulmonary Rehabilitation, 21(1), 24-30. Donker, Frank. (2000). Cardiac rehabilitation: a review of current developments. Clinical Psychology Review, 20 (7), 923-943. Goble AJ, Worcester MUC. (1999). Best practice guidelines for cardiac rehabilitation and secondary prevention: a synopsis. Heart Research Centre. Daoud, E. G., Dabir, R., Archambeau, M., Morady, F., & Strickberger, S. A. (2000). Randomized, double-blind trial of simultaneous right and left atrial epicardial pacing for prevention of post-open heart surgery atrial fibrillation. Circulation. 102, 761-765.
References Con t
Barber, K., Stommel, M., Kroll, J., Holmes-Rovner, M., & McIntosh, B. (2001). Cardiac rehabilitation for community-based patients with myocardial infarction: Factors predicting discharge recommendation and participation. Journal of Clinical Epidemiology. 54(10), 1025-1030. Hasnain,. D ,Philip,H.E & John, L.C (2004) Recent development in secondary prevention and cardiac rehabilitation after acute myocardial infarction. BMJ Publishing Group. 328, 693-697. Kate,J.R.(2003) Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularization: design and rationale of the Birmingham rehabilitation uptake maximization study: a randomized controlled trial. BioMed Central Cardiovascular Disorders. 3 (10) p.14712261 Evenson, K.R., Johnson, A., & Aytur, S.A. (2006). Five-year Changes in North Carolina Outpatient Cardiac Rehabilitation. [Electronic Version]. Journal of Cardiopulmonary Rehabilitation, 26, 366-376.
References Con t
Mittag, O., China, C., Hoberg, E., Juers, E., Kolenda, K., Richardt, G., Maurischat, C., & Raspe, H. (2006). Outcomes of Cardiac Rehabilitiation with versus without Follow-up Intervention Rendered by Telephone (Luebeck Follow-up Trial): Overall and Genderspecific Effects. [Electronic Version]. International Journal of Rehabilitation Research, 29, 295-302. Pierson, L. M., Norton, H. J., Herbert, W. G., Pierson, M. E., Ramp, W. K., Kiebzak, G. M., Fedor, J. M., Cook, J. W. (2003). Recovery of self-reported functional capacity after coronary artery bypass surgery. Chest, 123(5), pp.1367-1374. Goodman, J. M., Pallandi, D. V., Reading, J. R.; Plyley, M. J.; Liu, P. P., Kavanagh, T. (1999). Central and peripheral adaptations after 12 weeks of exercise training in post-coronary artery bypass surgery patients. Journal of Cardiopulmonary rehabilitation, 19(3), pp. 144-150.
References Con t
Evenson, K.R., Johnson, A., & Aytur, S.A. (2006). Five-year Changes in North Carolina Outpatient Cardiac Rehabilitation. [Electronic Version]. Journal of Cardiopulmonary Rehabilitation, 26, 366-376. Mittag, O., China, C., Hoberg, E., Juers, E., Kolenda, K., Richardt, G., Maurischat, C., & Raspe, H. (2006). Outcomes of Cardiac Rehabilitiation with versus without Follow-up Intervention Rendered by Telephone (Luebeck Follow-up Trial): Overall and Gender-specific Effects. [Electronic Version]. International Journal of Rehabilitation Research, 29, 295-302.