Phases of Cardiac Rehabilitation (for health professionals)

PHASE I
  1. External referrals have their phase 1 at the interventional centres.
  2. Within the trust all inpatients referred to the Cardiac Rehabilitation Nurse Specialist (CRNS) are usually seen within two days of referral with or without a family member* being present. *Denotes a person whom the patient wishes to have present
  3. The CRNS explains to the patient his or her reason for admission and a brief explanation of what happens when someone has a heart attack is given.
  4. Those patients waiting for transfer for angiogram are given information regarding the procedure.
  5. The difference between Angina/Acute Coronary Syndrome and Heart Attack are discussed. What the patient should do if they experience certain symptoms after they are discharged home from hospital.
  6. An explanation of all medication the patient will be discharged on is given by the pharmacist including side effects, how and when the tablets should be taken and any other special instructions.
  7. The CRNS explains all the Risk Factors of Coronary Heart Disease with the patient - Heredity, Gender, Smoking, High Blood Pressure, Age, Cholesterol, Diabetes, Obesity, Lack of Exercise and Stress
  8. It is explained to the patient what Risk Factors can be changed and those that cannot with a special emphasis on the patients own Risk Factors.
  9. Advice is given on ways the patient can change their Risk factors & the importance of doing so.
  10. Discharge advice is given on how to increase levels of activity during the first few weeks post discharge before they commence the cardiac rehabilitation programme.
  11. Patients are also advised on other activities such as:- Sexual Intercourse, driving, Air Travel, Returning to work.
  12. Patients are provided with all the necessary literature concerning everything that was discussed with them.
  13. Any necessary referrals are also made for the patients i.e. Dietician or Social Worker.
  14. Information regarding the Cardiac Rehabilitation programme is given to the patient.
  15. Patients and family member are then given the opportunity to ask any questions and a contact number for the CRNS is provided.

PHASE II
  1. Patients referred who are not seen at phase 1 are sent an invite letter for the cardiac rehabilitation programme with a consent form to complete and return.
  2. Contact is maintained with consenting patients via telephone/e-mail until they come for their pre rehab assessment appointment.
  3. The purpose of the assessment is to assess patient’s suitability for the exercise component of the programme and to stratify their risk of future cardiac events. It gives the CRNS and the Cardiac Exercise Specialist a chance to meet and get to know those patients externally referred.

The assessment day usually takes the following format:
  • Cardiovascular Observations:- Blood Pressure and Pulse.
  • Nursing Assessment:- Past Medical History, current physical & psychological status, exercise history and current exercise. Medication, Weight, Waist Circumference, Risk Factors, Explanation of Borg Scale* and content of programme. *The Borg Scale is a scale of Perceived Exertion has been used in medicine and research to establish limits. It is simply an indicator of how you feel after exertional exercise.
  • Shuttle Walk:- The cardiac exercise specialist undertakes a 10 metre progressive shuttle walk with the patient to assess exercise capacity.

Patients are then given a start date for the Cardiac Rehabilitation Course along with a timetable for the course content. The CRNS then discusses the assessments with the Cardiologist who then Risk Stratifies each patient.

Risk Stratification

Patients are risk stratified by the Cardiologist into three categories based on the following
criteria:-

Low Risk
Uncomplicated recovery from small Myocardial Infarction
No previous Myocardial Infarcts
No Angina

Medium Risk
Previous Myocardial Infarcts or previous Angina
Satisfactory recovery from recent Myocardial Infarction
Not being treated for Heart Failure

High Risk
Recent large Myocardial Infarction
Receiving treatment for Heart Failure
Angina on mild or moderate exertion

PHASE III

  1. Patients commence the four week/eight session Cardiac Rehabilitation programme.
  2. They attend two sessions per week for 1½-2 ½ hours depending on which programme they attend.
  3. Most sessions consist of an hours exercise, a ½ hours relaxation session and an hours information and support session with an opportunity to ask questions at the end of each session.
  4. Patients relatives are invited to attend particular sessions which would be of interest to them.
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