Cardiac Rehabilitation
Recovery from cardiac surgery is not over when a patient is discharged from the hospital. Most patients have a long recovery ahead of them. Many institutions have cardiac rehabilitation programs to assist patients in their recovery and return to health. The goal of these programs is to not only assist in recovery from surgery but also to decrease the risk of future cardiovascular disease by improving risk factors.
In this chapter, you will learn:
1. The four phases of cardiac rehabilitation programs
2. Risk factors targeted in secondary prevention programs, including cardiac rehabilitation programs
CARDIAC REHABILITATION
Cardiac rehabilitation programs are multidisciplinary programs designed to reduce the risk of cardiovascular events. These programs are considered secondary prevention programs since they are designed to reduce the risk of events, such as myocardial infarction or stroke, in patients who are known to have cardiovascular disease. (Primary prevention refers to the attempt to prevent a disease from occurring in the first place.) Usually, insurance must cover the cost of cardiac rehabilitation for patients to be able to participate.
Cardiac rehabilitation programs and other secondary prevention programs begin with an extensive baseline patient assessment. These programs contain several core components designed to reduce cardiovascular risk, promote healthy behaviors, encourage exercise, and reduce disability in patients with cardiovascular disease. The components focused on by these programs include nutritional counseling, risk factor management, physical activity counseling, and exercise training. Risk factor management involves optimizing treatment of lipids, blood pressure, weight, diabetes mellitus, and smoking. Finally, cardiac rehabilitation programs use psychosocial interventions designed to improve factors such as depression, marital or family distress, and substance abuse, which interfere with health. Cardiac rehabilitation programs consist of four phases.
FAST FACTS in a NUTSHELL 
Cardiac rehabilitation programs are designed to improve health and prevent progression of cardiovascular disease.
Phase I
Phase I of cardiac rehabilitation begins in the hospital after a cardiac event (myocardial infarction, stent placement, or cardiac surgery). This phase consists of supervised exercise and education about medication, diet, exercise, and reducing risk factors for coronary artery disease. Often, the education consists of a structured class that patients and family members attend prior to discharge.
Phase II
Patients enter phase II of cardiac rehabilitation between 2 and 6 weeks after discharge. A physician referral is required. The goal of phase II is to return patients to a normal active life. This is accomplished by improving functional capacity and endurance, providing education about lifestyle changes, increasing activity or exercise while reducing fear, and assisting with psychosocial adjustments after surgery.
The major emphasis of phase II is education, which may consist of individual or group classes. Family members are encouraged to attend with patients. Education topics include medications, lifestyle changes, goal setting, nutrition, stress management, and safely performing various activities. Most phase II programs meet for 1 hour three or more times per week for 12 weeks. Supervised exercise sessions include monitoring of telemetry and blood pressure.
Phase III
Phase III of cardiac rehabilitation is a continuation of phase II; however, patients may be referred by a physician into phase III without having gone through phase II of the program. Phase III is usually entered 6 to 14 weeks after discharge. The goals of phase III are to provide ongoing supervised exercise, offer continuing support for lifestyle changes, achieve independence, and prevent progression of cardiovascular disease. Supervised exercise takes place three or more times per week, with blood pressure and telemetry monitoring.
Phase IV
Phase IV of cardiac rehabilitation is for patients who have completed any of the previous phases. It involves continuing work on lifestyle changes. Exercise continues three or more times per week with minimal supervision.
FAST FACTS in a NUTSHELL
Cardiac rehabilitation programs have four phases. Phase I takes place in the hospital prior to discharge. Phases II and III may be entered with a physician referral without having gone through previous phases. Phase IV is a continuation of work done in one of the first three phases.
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