Preventive Cardiology & Rehabilitation

Who should participate in a Preventive Cardiology Program?

Cardiovascular disease is the number one killer of men and women in the United States. If you want to lower your risk for cardiovascular disease, or more importantly, if you have risk factors or have already been diagnosed with cardiovascular disease, this program is for you. Even if you already have cardiovascular disease, you can slow its progression by managing your risk factors.

What types of patients are seen in the Preventive Cardiology Clinic?

Patients in the Preventive Cardiology Clinic can be categorized as receiving primary or secondary prevention.

• Primary prevention is aimed at the prevention of heart and blood vessel disease before an event such as a heart attack or stroke, or the need for cardiovascular surgery occurs.
• Secondary prevention targets individuals after they have experienced an event such as heart or vascular surgery, angioplasty or heart attack, to prevent further progression of cardiovascular disease.

Who is the clinical team?

The Preventive Cardiology Program brings together the multi-specialty expertise of physicians, nurse practitioners, nurses and other health care professionals from several departments, including:

• The Tomsich Family Department of Cardiovascular Medicine
• Endocrinology
• Hypertension
• Internal Medicine
• Exercise Physiology
• Psychology
• Nutrition Therapy

In bringing these diverse areas together under one program, patients benefit from this comprehensive, multi-specialty expertise and application of the most current, research-based preventive therapies.

How do I enter the program?

Your doctor can arrange for you to be seen in the Preventive Cardiology Program or you may contact us directly to schedule an appointment at 215.444.9353 or toll free 800.223.2273, ext. 49353. Once your appointment is made, you will receive information and instructions to prepare you for your first visit.

What role does my primary physician have?

The Preventive Cardiology specialists will work closely with you and your family physician or cardiologist to design a program which fits with your overall health profile. They will track your progress and report this information to you and your doctor with each visit.

What are the program goals?

The team works with each patient individually, using research-based interventions and a variety of treatment methods to decrease risk factors for cardiovascular disease progression and improve quality of life. Your goals will be individualized to your needs and lifestyle.

Patients begin with a complete risk assessment and lab work including biochemical and genetic markers, followed by a long term plan for reducing risk. Nutritional counseling, exercise instruction, advice about lifestyle and behaviors, smoking cessation, medical management of risk factors, psychological counseling and referral to physicians or other health professionals as needed may all be a part of this plan.

What happens during my first visit?

You will receive a thorough risk factor assessment including family history of cardiovascular diseases, assessment of lifestyle health behaviors, review of your cardiovascular and other medical history, lab work including diabetes and cholesterol screening and a focused cardiovascular physical. We also screen for new and emerging risk factors for heart disease, such as homocysteine, fibrinogen, lipoprotein(a) and C-reactive protein. Review common risk factors for heart disease.

What happens next?

The data obtained from your comprehensive evaluation is reviewed by members of our multidisciplinary team, and an individualized treatment plan is created that includes specific goals to be followed over time. Your information is entered into a computerized database, and you will be provided with a sheet to track your information. This database will make it easy for you and your healthcare providers to follow your progress, comparing trends over time. The database also allows for analyses of outcomes to help us evaluate how well we are meeting the goals of our patients. A copy of these records can automatically be sent to your referring physician and any other physicians you would like to be kept informed of your care.

How often will I have follow-up appointments?

Most patients have a follow-up appointment every 3 months, but they may be more or less frequent depending on their individual needs and plan of care. Regular follow-up visits are important to ensure progress toward goal achievement. If you have questions in between visits, you may contact your Preventive Cardiology team.

What makes Cleveland Clinic’s Preventive Cardiology Program unique?

The program has been designed to provide:

• Individualized treatment plans
• Cutting-edge risk evaluation, including the latest new and emerging risk factors
• Computerized data collection and outcome analyses
• Multidisciplinary treatment strategies
• Nutritional counseling based on individual lab test results and patient needs, and may include electronic evaluations of daily food intake
• Behavioral analysis
• Group and individual educational programs

What is Cardiac Rehabilitation?

Cardiac rehabilitation (rehab) is a program designed to help improve your overall health by identifying and reducing the risk factors that lead to cardiovascular disease.

The program promotes optimal life-style changes and medical management to:

• Prevent the occurrence and/or progression of cardiovascular disease
• Reduce your risk of a heart attack or stroke
• Reduce the need for future surgery
• Enhance your quality of life by reducing symptoms

How will cardiac rehab help?

As a participant in the Cardiac Rehab Program, you will work with an exercise physiologist or registered nurse who will help you meet your personal goals.

The goals of cardiac rehab are to:

• Increase your understanding about your condition and treatment
• Help you make the right lifestyle changes to decrease your risk of a heart attack or stroke and reduce the need for future surgery
• Increase your ability to perform your job and your daily or recreational activities
• Provide you and your family with the support and motivation you need to make important lifestyle changes

Who can benefit from cardiac rehab?

Cardiac Rehab Programs benefit patients who have:

• Coronary artery bypass graft (CABG) surgery
• Interventional procedures such as balloon angioplasty, PTCA, atherectomy, rotoblation or stent placement
• Angina
• Heart attack (myocardial infarction)
• Heart failure
• Hemodynamic disorders, such as syncope
• Peripheral artery disease
• Other heart or vascular disorders
• Valve repair or replacement
• Aortic aneurysm repair or replacement
• Heart transplant

How do I get started in the Cardiac Rehab Program?

• Phase I Cardiac Rehab: During your hospital stay, a cardiac rehab specialist will direct your early activities. You will receive information about the recovery process and learn how to reduce your future risk of cardiovascular disease.
• Phase II Cardiac Rehab: Soon after you are discharged from the hospital, you can enter the outpatient Phase II Cardiac Rehab Program. Once your doctor has provided a referral, the rehab team can help you get started in the program.
  
  Your first visit will include an exercise evaluation for safety, a discussion about exercise guidelines, a review of your medical history and an evaluation of your cardiovascular disease risk factors.

What does the program include?

• We will develop a plan with you and your family that includes strategies to help you make lifestyle changes and decrease your risks. The program will be tailored to your personal needs, abilities and interests.
• Patient and family education classes are provided every week along with individual education to help you achieve your personal goals. Detailed nutrition counseling is also available with our registered dietitian.
• The program will support the ongoing care provided by your referring doctor.
• We will track your progress throughout your participation in the program and report this information to you and your referring doctor.

Where will I go to participate in the program?

Cardiac rehab activity classes are offered at Cleveland Clinic.

All sessions are medically supervised and directed by nationally certified rehabilitation specialists and nurses. State-of-the-art monitoring equipment and a variety of exercise equipment are available for your safety and convenience.

Ongoing Management

In addition to the Cardiac Rehab Program, you may participate in the Preventive Cardiology Clinic. This multispecialty clinic includes physicians, nurse practitioners, nurses and other healthcare professionals from several departments, including cardiovascular medicine, endocrinology, hypertension, internal medicine, exercise physiology, psychology and nutrition therapy who are experts in the prevention of cardiovascular disease.

The specialists in the Preventive Cardiology Clinic assess your risk of cardiovascular disease and create a plan to manage traditional and emerging risk factors. The team works with each patient individually, using research-based interventions and a variety of treatment methods.

Does insurance cover cardiac rehab?

Outpatient cardiac rehab is covered by most insurance companies. We can help you contact your insurance company to ask about your coverage options before you start the Phase II Cardiac Rehab Program. Or you may call the financial counselor at 216.444.9353 or 800.223.2273 ext. 49353

Why attend the Cardiac Rehab Program?

• The program is part of the Sydell and Arnold Miller Family Heart & Vascular Institute, which has been ranked the #1 cardiac program since 1995 by U.S. News & World Report.
• Our program is certified by the American Association of Cardiovascular and Pulmonary Rehabilitation.
• All Cleveland Clinic medical records are centralized, so you and your physicians have immediate access to your information.
• Participants in a comprehensive program have a 25 to 30% reduction in fatal heart events.
• Our participants have an average 25% increase in exercise capacity.
• You’ll receive a full medical evaluation, exercise test for safety and effectiveness, and we’ll create a program designed to meet your specific goals to help you reduce all risk factors for heart disease.
• Participants work with the same rehab staff member throughout the entire program.
• Staff members are certified exercise specialists and are certified in advanced cardiac life support.
• The program is integrated with the Preventive Cardiology program.
• An on-staff registered dietitian is available for consultations.
• Learn about choosing a cardiac rehabilitation program.

The Pediatric Preventive Cardiology and Metabolic Clinic is a multidisciplinary team of physicians, nurse practitioners, dietitians, exercise physiologists and other healthcare professionals who take a comprehensive approach to preventing the onset/progression of cardiovascular and metabolic conditions in high risk pediatric patients. Our team works with families to create individualized programs to meet the specific needs of each patient.

The Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic is a recognized world leader in diagnosis and treatment of cardiovascular disease and has been ranked best in the nation for cardiac care by U.S. News & World Report every year since 1995.

Pediatric Preventive Cardiology and Metabolic Clinic Team

• Naim Alkhouri, MD, Clinical Director - Pediatric Gastroenterology
• Michael Rocco, MD - Preventive Cardiology and Rehabilitation
• Erin Henry, CNP - Preventive Cardiology and Rehabilitation
• Gordon Blackburn, PhD - Preventive Cardiology and Rehabilitation
• Julia Zumpano, RD, LD - Preventive Cardiology and Rehabilitation Nutrition Program
• Richard Lorber, MD - Pediatric Cardiology
• Douglas Rogers, MD - Pediatric Endocrinology
• B. Michelle Schweiger, DO  - Pediatric Endocrinology
• Jyoti Krishna, MD - Sleep Disorder Clinic

Referrals

If you are interested in having your child or adolescent referred to the Pediatric Preventive Cardiology / Metabolic Clinic, the criteria for referral include the following:

• Less than 21 years of age
• Metabolic/Lipid abnormalities. BMI above the 95th percentile without other cardiac or metabolic risk factors BMI above the 85th percentile and other cardiac or metabolic risk factors including:
  • HDL < 50 mg/dL
  • LDL > 110 mg/dL (fasting)
  • Triglycerides > 150 mg/dL (fasting)
  • AST/ALT > upper limit of normal
  • Blood pressure > 130/85 mm/HG
• Regardless of BMI:
  • LDL > 130 mg/dL (fasting)
  • Triglycerides > 250 mg/dL (fasting)
  • Ultrasound evidence of fatty liver
• Genetic dyslipidemias. Patients with significantly elevated cholesterol and/or triglycerides and genetic lipid disorders such as:
  • Heterozygous / Homozygous FH
  • Severe polygenic hypercholesterolemia
  • Familial combined hyperlipidemia
• Rheumatological disease.
  • Lupus
  • Juvenile arthritis
  • Vasculitis
  • Other rheumatological disease

If you have concerns about a patient who does not meet the referral criteria above, please contact us to discuss your patient further.

Comprehensive Initial Consultation

• thorough risk factor evaluation
• review of lifestyle health behaviors
• assessment of family history of cardiovascular/medical disease and lipid abnormalities
• lab work, including a biochemical profile and screenings
• imaging studies, if appropriate
• focused physical exam
• nutritional assessment
• psychological assessment

Treatment Plan May Include

• lifestyle changes
• non-pharmacologic approaches to lipid lowering
• lipid-lowering medications, if appropriate
• dietitian consultation
• exercise prescription
• psychological intervention
• assessment for obstructive sleep apnea

Follow-up

• regular follow-up is emphasized to ensure progress towards goals
• each patient’s progress is tracked over time and reported to you

The Sydell and Arnold Miller Family Heart & Vascular Institute Preventive Cardiology Nutrition Program is based on scientific research and national recommendations. We believe that diet and lifestyle management is at the foundation of heart disease risk reduction. Our nutritional guidelines are based on extensive epidemiological and clinical research involving diet patterns associated with a reduced risk of cardiovascular disease.

These dietary recommendations include those established by the American Heart Association and National Cholesterol Education Program, yet are broadened to include and emphasize cardioprotective, health-enhancing foods such as unrefined grains, fruits, vegetables and legumes. These dietary patterns have been linked to a reduction in coronary disease risk as well as other debilitating conditions such as cancer, obesity, diabetes and hypertension.

Nutrition recommendations in the Preventive Cardiology Nutrition Program are unique to an individual’s health needs, lifestyle and goals. Incorporating a variety of cardioprotective, plant-based foods set the stage for prevention. We believe prevention of heart disease can be achieved when the following life strategies are emphasized:

• Achieving or maintaining a healthy body weight.
• Minimizing refined starches and simple sugars and emphasizing fiber-rich foods to achieve weight goals and reduce cardiovascular risk factors.
• Minimizing saturated and trans fat and optimizing unsaturated fat food sources, with a special emphasis on omega-3 fatty acid food sources.
• Choosing a variety of plant-protein foods and de-emphasizing protein from animal sources.
• Enhancing the whole foods concept to reap the cardioprotective benefits from legumes, unrefined grains, fruits and vegetables.
• Engaging in a regular physical activity regimen.

The Preventive Cardiology Nutrition Program offers a wide-array of resources to help our patients enhance their overall health and maximize their reduction of heart disease.

Nutrition services include:

• Individualized goal setting and nutrition counseling. This includes a thorough nutrition assessment utilizing your nutritional history, medical history, body mass index, risk factor evaluation, and lab work as needed. This service can be obtained in one of two ways:
  • Face to face interaction in our Main Campus Preventive Cardiology & Rehabilitation clinic. Call 216.444.9353 or toll free 800.223.2273, ext. 49353 to schedule an appointment.
  • In the comfort of your own home, via our new eNutrition Counseling - a web based nutrition counseling program. Pull down the menu "MyConsult" and go to "Nutrition".
• Educational Materials. We offer a variety of educational handouts and materials to support healthy eating, grocery shopping, food preparation and dining out (link to web information). We are continuing to strive to provide the most up-to-date materials to our patients.
• Cooking classes and recipes.
• Nutrition research. We participate in and actively seek out nutrition oriented research activities to help us learn more about the role of nutrition in disease prevention.
• Corporate consultation. We provide corporate lectures and nutritional expertise to corporations all over the country. We can also provide assistance to grocery stores to help with marketing healthful foods and educating consumers on healthful food choices.
• Group education:
  • Weigh to a healthy heart is a 10 week group weight loss program, part of Preventive Cardiology Nutrition Services.
  • Shared Medical Appointments allows an opportunity to discuss nutrition and health needs with a dietitian and nurse practitioner.

To a great degree, health is a product of the choices we make every day about what we eat, how much we exercise, and how knowledgeable we are about our own risks for disease. Our energy level, ability to concentrate and manage our weight, blood sugar and cholesterol – these are but just a few of the many conditions that can be favorably influenced when we provide our bodies with the right mix of nutrients, in the right amounts.

For more information on any of the above services, please contact Julia Renee Zumpano RD, LD or Kate Patton, MED, RD, CSSD, LD, Preventive Cardiology & Rehabilitation Office locally at 216.444-9353 or toll free 800.223.2273, ext. 49353 or Contact Us..