Heart Health Heart Healthy Lifestyle

Don't Bypass Cardiac Rehabilitation

Who makes up the cardiac rehabilitation team?
Our program, which I think is typical, involves nurse clinicians and exercise physiologists. They're involved on a day-to-day basis. We have a medical director, who's a clinical cardiologist, who oversees the entire program, though the staff is highly independent. Most programs have also access to a registered dietician and a psychologist, or have them on staff.

Do patients have a medical evaluation before entering a program?
All patients are evaluated by the nurse clinician and the exercise physiologist. Most programs encourage the patient to undergo an exercise stress test (having them walk on a treadmill, while their heart rates, blood pressures, and any symptoms are observed) in an effort to determine their safe exercise capacity.

What does the rehabilitation process consist of?
There are three phases of cardiac rehab. The program starts while they are still in the hospital recovering from the heart attack. If they're clinically stable, we want to get them up, out of bed, doing self-care activities and low-level walking as soon as possible.

Then the patient comes to an outpatient facility for phase II of cardiac rehab. Some arrive within a week of hospital discharge. More often they come two, three, four, five weeks after a hospital discharge. This portion of rehab includes an electrocardiogram (ECG)-monitored exercise program, where small groups of patients come in three days per week. It typically lasts between 4 and 12 weeks.

Then the long-term maintenance is what we call phase III or phase IV. And we've had patients involved in our long-term maintenance for more than 20 years.

Are all of the phases covered by insurance?
Phase I is covered, and 80 percent or more of phase II is usually covered. Phase III is not covered by insurance, and then the challenge is to provide a weekly or monthly fee that's reasonable to the patient. In our particular case, the cost is about $80 per month.

What is the ultimate goal of a cardiac rehab program?
The ultimate goal is to reduce morbidity and mortality, to improve the quality of life, to reduce subsequent hospitalizations, and to get people back into a meaningful vocational and leisure time activity.

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