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1、Cardiac Rehabilitation 2021Update for Primary Care ProvidersDouglass A Morrison, MD, PhDDouglass A Morrison, MD, PhDCardiac Rehabilitation, Medical DirectorCardiac Rehabilitation, Medical DirectorYakima Regional and Yakima Valley Memorial Yakima Regional and Yakima Valley Memorial HospitalsHospitals
2、RehabilitationTo restore to good health or useful life, through therapy and education. Changing our own behavior, for better healthChanging BehaviorResistancesTherapy: connotation of mental illnessRehabilitation: connotation of substance abusePersonal Responsibility is much more difficult than blami
3、ngNo one can rehabilitate another; most of the work is done by the patient, for himself.Active versus PassiveSecond Person versus First PersonIt is easier to tell others how they should change,than to change ourselves: empathyCardiac Rehabilitation 2021Bill of Fare1.What is cardiac rehabilitation?2.
4、What is the difference between primary and secondary prevention?3.Is there good clinical evidence which supports the efficacy of cardiac rehabilitation?SurvivalMyocardial infarct (MI) reductionStroke (CVA) preventionAvoidance of subsequent bypass surgery (CABG)Reduced repeat stenting (PCI)Reduced fr
5、equency of hospitalizationCardiac Rehabilitation 2021Bill of Fare (2)4. Does the evidence, which supports the use of cardiac rehabilitation apply:In the reperfusion-era of post MI care?To the elderly (Medicare population)?Women?Care-givers, themselves?5. In your personal, and professional experience
6、, is behavior change:Easy, i.e. a slam-dunk?Impossible, and therefore, not even worth discussingPossible, but requiring sustained effortDefinition of Cardiac RehabilitationA multi-component intervention, which is designed to:Optimize a cardiac patients physical, psychological and social function, an
7、dStabilize, slow, or even reverse the underlying atherosclerosis; therebyReducing the morbidity and mortality of coronary artery disease (CAD).Physical Activity and the Prevention of Coronary Heart DiseaseMeta-analysis of 43 studies from world literature of physical activity and CAD up to 1987Object
8、ive assessments of individual activity, and of CHD Attempt to infer causal relationship based on criteria of AB Hill and RothmanSequence: activity precedes incidence of CHDConsistency across studiesStrength of association Graded across multiple levels of activityPlausibilityCoherenceSupported by bio
9、logical studiesPowell et al; Ann Rev Public Health1987;8:253Diet, Exercise, and Smoking Modification after acute coronary syndrome (ACS)18,809 patients from OASIS 5 prospective randomized trial, conducted in 41 countries.Most patient were compliant with aspirin (96%); statins (79%); ACE-I/beta block
10、ers (72%).29% did not follow diet or exercise; 1/3 of smokers persisted; 42% did either diet or exercise; 30% did both diet and exercise.MI risk reduced significantly by diet, exercise and smoking cessation.Circulation 2021;121:750-758Cardiac Rehabilitation:Contemporary Era and Elderly Population601
11、,099 Medicare beneficiaries, who were hospitalized for coronary conditions and/or revascularization (PCI or CABG).1- 5 year mortalities examined using multiple statistical methodsOnly 12% used cardiac rehabilitation services; they averaged 24 sessions.Mortality rates were 21-34% lower among users of
12、 cardiac rehabilitationDose-response noted: more is better.Performance Measures for Primary Prevention1.Risk factor screening2.Dietary counseling3.Physical activity counseling4.Smoking assessment5.Smoking cessation intervention6.Weight/adiposity assessment7.Weight management8.Blood pressure measurem
13、ent9.Blood pressure control10.Lipid measurement11.Lipid control12.Global risk assessment13.Aspirin use14.Circulation 2021;120:1296-1336.Core Components of Cardiac Rehabilitation/ Secondary PreventionEvaluationPatient assessmentNutritionalWeight managementBlood pressureLipidsDiabetesSmoking Psychosoc
14、ialPhysical ActivityExercise trainingInterventionCardiac Rehabilitation 2021: Summary (1)Neither coronary bypass graft surgery (CABG), nor percutaneous coronary intervention (PCI), with or without stents, have been shown, in stable patients, to prevent heart attacks.Cardiac Rehabilitation 2021: Summ
15、ary (2)Lipid lowering (primarily with statin drugs such as Lipitor, Crestor, or Zocor); Aspirin; Beta-blockers; and ACE-inhibition; have all been shown to reduce the risk of future myocardial infarction (MI), among post MI patients, and patients with stable coronary disease.Compliance can be enhance
16、d with the educational component of cardiac rehabilitation.Cardiac Rehabilitation 2021: Summary (3)Diet, exercise, and smoking cessation have been shown to reduce the risk of subsequent heart attack.Cardiac rehabilitation, in a large, Medicare study, has been sown to be associated with reduced likel
17、ihood of heart attack.Getting people to take personal responsibility for their own health involves behavior modification. It is not easy, but we can all do it, one step at-a-time.When we study biology, we are life, contemplating its nature. George Wald, PhD In the catheterization lab, or echo lab, or exercise lab, or pulmonary function lab,We are contemplating lifes natureAnd we are applying the fruits of our contemplations to the care of our fellow human.We follow the same biological principles.Care-Giver,Heal Thyself
