Unstable angina non ST elevation myocardial infarction cardiac rehabilitation
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Overview of Cardiac Rehabilitation in UA / NSTEMI
The U.S. Public Health Service definition[1] of cardiac rehabilitation states that:
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Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. These programs are designed to limit physiological and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients. |
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Cardiac rehabilitation, also called cardiac rehab(CR), is a medically supervised program to help cardiac patients recover quickly and improve their overall well being. Cardiac rehabilitation programs are designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients. Cardiac rehab may occur in a variety of settings, including medically supervised groups in a hospital, physician’s office, or community facility. Education and counseling concerning risk factor modification are individualized, and close communication between the treating physician and cardiac rehabilitation team may promote long-term behavioral change. A randomized clinical trial of cardiac rehabilitation following MI by Witt et al[2] found that participants in cardiac rehab programs had a lower risk of death and recurrent MI at 3 years. In this study, half of the eligible patients participated in cardiac rehabilitation after MI, although women and older adult patients were less likely to participate, independent of other characteristics. Study, however, did not show any beneficial effect on recurrence of nonfatal MI. Another study by Wenger et al[3] demonstrated that cardiac rehabilitation comprising exercise training and education, counseling, and behavioral interventions yielded improvements in exercise tolerance with no significant cardiovascular complications, improvements in symptoms (decreased anginal pain and improved symptoms of HF such as shortness of breath and fatigue), and improvements in blood lipid levels; reduced cigarette smoking in conjunction with a smoking cessation program; decreased stress; and improved psychosocial well-being. Other studies have also shown reduction in total cholesterol, LDL-C and HDL-C as well. Studies have shown that fewer than one third of patients with MI receive information or counseling about cardiac rehabilitation before being discharged from the hospital. Physician referral is the most powerful predictor of patient participation in a cardiac rehabilitation program.
Patient reasons for nonparticipation and noncompliance include affordability of service, insurance coverage/ noncoverage, social support from a spouse or other caregiver, gender-specific attitudes, patient-specific internal factors such as anxiety or poor motivation, and logistical and financial constraints, or a combination of these factors.
ACC / AHA Guidelines (DO NOT EDIT) [4]
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Class I1. Cardiac rehabilitation / secondary prevention programs, when available, are recommended for patients with UA / NSTEMI, particularly those with multiple modifiable risk factors and those moderate to high risk patients who supervised or monitored exercise training is warranted. (Level of Evidence: B) |
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See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [4]
References
- ↑ Clin Pract Guidel Quick Ref Guide Clin. 1995 Oct;(17):1-23. Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute. Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA, Certo CM, Dattilo AM, Davis D, DeBusk RF, et al. PMID: 8595435
- ↑ Oldridge NB, Guyatt GH, Fischer ME, Rimm AA (1988). "Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials". JAMA. 260 (7): 945–50. PMID 3398199. Unknown parameter
|month=ignored (help) - ↑ Wenger NK, Froelicher ES, Smith LK; et al. (1995). "Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute". Clin Pract Guidel Quick Ref Guide Clin (17): 1–23. PMID 8595435. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
|month=ignored (help)