CARDIAC REHABILITATION

CARDIAC REHABILITATION

Dr Massimo Cernili, Cardiac Specialist

The cardiac rehabilitation process consists of various stages. These include: general clinical and diagnostic evaluation, assessment of nutritional status, optimization of drug therapy, psycho-educational and nutrition programme, tailored physical training and examinations (ECG and arterial pressure monitoring), instrumental evaluation (non-invasive cardiac diagnostic evaluation, dynamic ECG, echocardiography, Colour Doppler, Echo stress test, Holter blood pressure monitoring and telemetric monitoring). Patients thus work in close contact not only with physicians but also with physiotherapists, psychologists and dieticians.

Hospital Care

Patients can be treated through:

■ Day Hospital care (for patients with suitable clinical and logistical conditions)

■ Ordinary Hospitalization (for patients suffering from the most severe functional impairments)

Waiting time

For Day Hospital admission    based on bed availability

For Ordinary Hospitalization based on bed availability, up to a maximum of 15 days

Booking

Booking can be made either by phone (0536 42039) or in person at the Hospital Admission office

Diseases and Conditions Treated

Cardiac Rehabilitation is:

 designed for patients:

  • following cardiac surgery involving coronary artery bypass surgery and/or heart valve replacement
  • following myocardial infarction
  • suffering from other disabling heart conditions such as cardiac failure

recommended for patients preparing to undergo thoracic and cardiac surgery

Main goals

The goal of the Rehabilitation Plan is to speed up the recovery of the patient’s autonomy and their subsequent psychosocial readjustment. To this end, the team has designed rehabilitation programmes which, based on the most advanced scientific knowledge, deal with both the comprehensive diagnostic evaluation stage and the treatment stage in an interdisciplinary manner, combining traditional cardiac assessment and physical rehabilitation techniques with educational and occupational therapy programmes.

 

Individual Rehabilitation Plan

The Individual Rehabilitation Plan (IRP), developed by the cardiology physician in collaboration with the other professionals in the team (nurse, psychologist, rehabilitation therapist, nutritionist-dietician), combines the various components in a mutually enhancing way. It is patient-centred and, as such, is unique to each patient.

The IRP:

  •           provides a comprehensive overview of the patient’s functional status and residual capacities, using, wherever possible, scales validated and/or recognized by scientific communities
  •          defines the interventions that can help achieve the set goals, focussing on the various ascertained problems
  •           involves regular assessment of the results achieved and verification of expected goals, is shared with the patient and, if possible, with the family

 

The main areas of IRP intervention are:

  •         Comprehensive Diagnostic Evaluation and Interdisciplinary Assessment
  •         Nursing Care
  •         Rehabilitation Therapy
  •         Psychosocial Support
  •         Nutrition Support
  •        Education and Behaviour Programmes designed to help patients to control risk factors and symptoms, to learn more about their illness and how to use drug therapies correctly

Comprehensive Diagnostic Evaluation and Interdisciplinary Assessment

The comprehensive diagnostic evaluation, performed in the first days of hospitalization, analyses not only the clinical variables but also the psychological and social variables that may have influenced the development of the cardiovascular disease. The patient approach is developed by the interdisciplinary team which carries out an initial assessment of the patient and ascertains weekly the work done and goals achieved. When the patient is admitted, the cardiology physician will carry out a clinical examination and compile a detailed medical history in order to clarify and establish their specific therapeutic requirements. Should he deem it necessary, he can prescribe further, specialist visits and non routine tests; the latter include biohumoral and instrumental examinations designed to assess the patient’s state of health, particularly of their cardio-circulatory system, and whether there are any cardiovascular risk factors so that a suitable and tailored rehabilitation plan can be developed. The following examinations are carried out regularly during hospital stays

  • Chest X-rays, haematochemical tests
  • Six-minute walking test
  • Electrocardiogram and dynamic electrocardiograph for 24/h according to the Holter method
  • Colour Doppler mono-bidimensional echocardiography
  • Cardiac stress test on a cycle ergometer with possible evaluation of exhaled gases

Further frequently performed checks include Echo Doppler examination of the epiaortic vessels and Doppler examination of lower limb vessels (particularly on patients suffering from ischemic heart disease or if there is an indication for it) and monitoring of arterial blood pressure.

Nursing Care

The functions performed by nursing staff and care workers are essential in order to:

  • put into effect the intervention plans developed for the patient and related monitoring actions (prevention of surgical infections, treatment/prevention of skin lesions, taking care of primary needs, teaching the patient how to use anticoagulation therapy, cardiovascular risk prevention education and so on)
  • comfort and support the patient in tackling minor and major everyday challenges

Rehabilitation Therapy

It is conducted by rehabilitation therapists and, depending on the clinical case, includes:

  • respiratory gymnastics
  • sessions on the stationary bike or the treadmill
  • activities in set green areas of the vast pine wood (in the mild seasons)
  • callisthenics and muscle stretching
  • draining of secretions
  • magnet therapy

The cardiology physician, based on the issues that emerged during the diagnostic evaluation, will prescribe the type, duration and intensity of the physical therapy to be undertaken by the patient.

Rehabilitation activities both inside and outside the facility is conducted, if necessary, under strict telemetry supervision by qualified staff trained in accordance with the guidelines set by the Italian Group on Cardiac Rehabilitation (GICR).

Psychosocial Support

During the patient’s hospital stay, a clinical psychologist will perform a psychological assessment using psycho-diagnostic tests as well as one-to-one and group interviews. The aim is to evaluate the psychological and social factors that may be significant when planning goals and treatment strategies during and after the rehabilitation stage. Taking charge of the psychological aspect is now a well-established practice in cardiovascular rehabilitation plans. Clinical activities consist of relaxation techniques, individual consultations, psycho-educational groups and individual interviews to provide psychological support.

Relaxation activities are based on the techniques developed by Jacobson, Vogt and Schultz, in which patients learn strategies that enable them to control states of tension and deeply emotional states. The psycho-educational groups are subdivided in anxiety and stress management and smoking cessation groups. During group sessions, patients will be given information about their condition and its attendant complications and will be supported as they discuss and share their personal experiences.

Nutrition Support

The dietician arranges educational group meetings and, at the physician’s request, prepares specific diets that take into account the patient’s individual habits and needs.

Education and Behaviour Programmes

One of the most important aspects of rehabilitation is the need to radically change lifestyle and tackle risk factors, i.e. take action in order to reduce as much as possible the likelihood of further pathological events occurring in the future. This aspect of secondary prevention is one of the main goals. The programme includes multidisciplinary meetings (cardiologist, psychologist, nurses and rehabilitation therapist) which address particular issues relating to cardiovascular physiopathology, the psychological and emotional nature of the illness, acceptance of one’s condition, stress management, smoking cessation and healthy eating.

Hospital Discharge and Continuum of Therapy and Care

On completion of the rehabilitation plan, the team assesses the effectiveness of the interventions carried out and verifies whether planned goals have been attained, sharing the information with the patient. Together they agree on the patient’s return home or on the need for a hospital discharge under a continuing care scheme.

The cardiology physician fills out the hospital discharge letter, setting down the outcomes of the tests and examinations performed, the recommended drug therapy, any examinations to be carried out at home and the indications for an appropriate lifestyle that the patient will be required to follow.