Cardiac Rehabilitation

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Cardiac Rehabilitation

• Best Medicine for your patients with Coronary
  Artery Disease
• Why you should write the Prescription
• TODAY!

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Mission of Cardiac Rehab

• To restore and maintain an individuals optimal
  physiological, psychological, social and
  vocational status.

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Goals of Cardiac Rehab

• Identify, modify, and manage risk factors to
  reduce disability/morbidity mortality
• Improve functional capacity
• Alleviate/lessen activity related symptoms
• Educate patients about the management of heart
  disease
• Improve quality of life

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Core Program Components

• Risk factor management
• Baseline ongoing patient assessment
• Exercise/activity training

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What is Cardiac Rehabilitation?

• Medically supervised
• Lifestyle modification
• Monitored progressive exercise/activity
• Inpatient-Outpatient-Maintenance (Phase I, II,
  III)
• Individualized, typically 3x/week, up to 12 weeks
• Physician Referral Required

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Disease Management Components

• Population Identification processes
• Evidence-based practice guidelines
• Collaborative practice models
• Patient self-management education
• Process and outcomes measurement, evaluation,
  and management
• Routine reporting/feedback loop

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What Diagnoses are Covered?

• Medicare Guidelines
• Stable Angina
• Myocardial Infarction
• Coronary Artery Bypass Graft
• Private insurance coverage may vary

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Utilization Benefits

• Reduced risk of fatal MI (lt25).
• Decreased severity of angina need for
  anti-angina meds.
• Decreased hospitalizations.
• Decreased cost of physician office visits
  hospitalizations (lt35).
• Fewer ER visits.

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Physician Benefits

• Partnership in case management provides
• Enhanced access to physician services
• Consistent surveillance for improved clinical
  outcomes
• Improved patient satisfaction
• Patient education for self directed care
• Feedback on medications, exercise response and
  other appropriate issues

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Patient Benefits

• Improved functional capacity
• Increased knowledge of heart disease
• Improved adherence to positive lifestyle changes
• Better compliance with medical regime
• Increased self-esteem and confidence
• Reduced subsequent morbidity mortality r/t CAD

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Lifestyle Benefits

• Risk Factor and Lifestyle Modification
• Smoking cessation
• Lipid improvement
• Blood pressure control
• Exercise guidance
• Weight management
• Diabetes control
• Stress management

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Significant Statistics

• Cardiovascular disease accounts for almost 50 of
  all deaths in the U.S.
• Cardiovascular disease affects 13.5 million
  Americans each year
• Nearly 1.5 million Americans sustain myocardial
  infarctions each year

American Heart Association, Dallas Texas
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Utilization Trends

• Nearly 12.5 million Americans are eligible for
  cardiac rehab (secondary prevention)
• On average only 15 of these eligible candidates
  receive cardiac rehabilitation
• ranges between 11 and 30 depending on the area
  of the country

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Risk Factors

• Tobacco
• Smoking and Chew
• 50 decreased risk of CHD 1 year after cessation
• Hypertension
• 90 middle-aged Americans will develop HTN
• 35 million office visits/yr for HTN

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Risk Factors

• Hyperlipidemia
• 105,000,000 people with a tot chol gt 200
• 10 reduction in TC 30 reduction in incidence
  of CAD
• Physical Inactivity
• 76 billion
• gt 60 of Americans dont get sufficient exercise

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Risk Factors

• Obesity
• More than 50 women and 60 men are overweight or
  obese
• Nearly 300,000 American adults die of causes
  related to obesity
• Diabetes
• 58 reduction by lifestyle intervention
• 75 of people w/DM die of CAD or vascular disease

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Exercise Research

• Direct relation between inactivity and
  cardiovascular mortality. Inactivity is an
  independent risk factor for of CAD.
• Exercise capacity is a more powerful predictor of
  mortality among men than other established risk
  factors for CAD.
• Physical fitness has been clearly associated with
  improvements in lipid profiles.

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Medical Research

• Cardiac Rehab Professionals remain educated on
  the latest medical research
• New information is presented to your patients,
  so they can make informed decisions with you,
  their physician

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Cost-effectiveness/Cost-efficiency

• Medicare payments in hospital for CVD in 1997 was
  26.9 billion!
• Studies, adjusted for quality of life, show
  savings of 4,950-9,200 per year of life saved.
• Reduction in re-hospitalizations and medical
  costs are well documented.

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Cardiac Rehab Professionals

• Partners in Patient Care
• Medical Director
• Referring Physician
• Registered Nurses
• Exercise Physiologists
• Dieticians/Nutritionists
• Social Services/Psychosocial
• Pharmacists

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Who can Refer a Patient?

• Site-specific Policy
• Cardiologist
• Primary Care Physician
• Internist

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Communication with Rehab?

• Collaborative Approach
• Initial referral/plan of care
• Periodic Progress reports
• Program oversight by Medical Director
• Open ended lines of communication

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Cardiac Rehab adds Value

• Cardiac patients have many disease processes and
  lifestyle concerns that have contributed to their
  heart disease.
• Cardiac rehab serves the needs of each cardiac
  patient and works toward secondary prevention.
• Cardiac rehab adds VALUE to your patient care and
  increases QUALITY OF LIFE!

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CARDIAC REHABILITATION

• A REFERRAL IS A
• PHONE CALL
• AWAY!