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Did you know that cardiac diseases are the leading causes of death around the world? Cardiac rehabilitation helps improve health for those at risk. Cardiac Rehab Week is the second full week in February. Dr. Erik Van Iterson, Director of Cardiac Rehabilitation in the Section of Preventive Cardiology & Rehabilitation at Cleveland Clinic, provides an overview of the phases cardiac rehab.

Visit the Preventive Cardiology & Rehabilitation Center at Cleveland Clinic.

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Cardiac Rehabilitation

Podcast Transcript


Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy!

Erik Van Iterso

Thank you for tuning in with me for today's episode, focus on the topic of outpatient center-based cardiac rehab, also commonly known as phase two cardiac rehab. My name is Dr. Erik Van Iterson, and I am the Director of Cardiac Rehab at Cleveland Clinic Main Campus. My goal for this segment is to not only highlight the importance of cardiac rehab as a top-level guideline directed therapy following a major heart event or procedure, but to also provide both healthcare providers and patients with some brief guidance on the who, what, when, and wheres on how to actually get started with cardiac rehab, particularly if this is a new topic for you or one that you've typically experienced as challenging to find clear and concise information.

Now, if you weren't already aware or even if you were, it's worth emphasizing that decades worth of clinical research provides a robust body of supporting evidence highlighting the multitude of health benefits gained by participating and completing cardiac rehab as intended. These benefits included for many improved quality of life, increased cardiorespiratory fitness or also known as exercise tolerance, and importantly, lowered future risk of recurrent myocardial infarction, both fatal and non-fatal, as well as a lower risk of cardiovascular disease related death in the short, middle, and long-term follow-up.

Phase one cardiac rehab is known to begin while patients are still within the inpatient setting. During that time, the focus is getting the patient up and ambulating around the floors of the hospital, getting comfortable walking independently and for our cardiac rehab team or the members of the nursing staff to familiarize the patient with the next step in the recovery process. During that time, the cardiac rehab team may stop by the patient's room on several occasions to not only assist with the ambulation, but also to provide that education. Providing an overview of what cardiac rehab is, what it entails, what are the expectations from the patient, as well as from the cardiac rehab center, and to discuss what are the available options and to arrange scheduling if the patient already knows their schedule for the initial intake assessment.

For phase two cardiac rehab or outpatient center-based cardiac rehab: For most patients, the full immersion in this lifestyle based therapy for a standard dose of 36 sessions performed three hour-long sessions weekly amounts to more than three years of heart health benefits gained just by initiating and adhering to the cardiac rehab plan principles following a major heart event such as a myocardial infarction, percutaneous coronary intervention, also known as a PCI, or coronary artery bypass grafts, also known as a CABG. This is largely because cardiac rehab isn't just about heart healthy exercise training, but is also about providing patients with an individualized comprehensive prevention plan that involves crucial education on interrelated heart health topics that are relevant for the rest of their lives. This includes risk factor identification, assessment, goal setting, and action plans for both the short and long-term achievement of managing risk relating to potential hypertension, type II diabetes mellitus development, weight management, and dyslipidemia.

Throughout cardiac rehab, patients also learn as part of their plan. There's a critical importance of medication awareness and knowledge and the need for a close adherence to the prescriptive plan. Patients are also provided with resource options to help them address any potential mental health concerns given what they have recently experienced with their heart health scare. Other patients, in addition to those who experience in acute coronary event are also known to benefit them from all that cardiac rehab participation has to offer. These specific patients include those who have undergone surgery for a heart valve repair or replacement, those who have been diagnosed with chronic heart failure with a reduced left ventricular ejection fraction of 35% or less, or those who have had undergone surgery for a heart or lung transplantation. Even patients with established coronary artery disease who have not had a major procedure recently but are known to continue to experience stable chest pain called angina should be referred to cardiac rehab, since it has been shown that cardiac rehab can help with managing the severity of this symptom.

And so individuals who have been diagnosed with a heart condition or have had a recent heart procedure and they're not sure whether it falls specifically into one of the cardiac rehab eligibility categories, I highlight that it's important to ask your doctor for more information on eligibility, the heart condition that you've been diagnosed with, as well as contacting your insurance carrier to see if your specific plan will provide coverage for cardiac rehab based on your diagnosed heart condition. In most cases, despite the severity of some of the different types of heart surgeries, patients can typically expect to receive an order for cardiac rehab placed in their medical record by the time they're discharged from the hospital and be able to get started as early as three weeks and in some cases sooner.

At Cleveland Clinic we have a number of cardiac rehab locations dispersed over the Northeast Ohio region, 13 to be exact, which are all available options that patients are welcome to explore in order to identify which would be most convenient to attend on an ongoing basis. Specific cardiac rehab site location and contact information can be found on the Cleveland Clinic Heart, Vascular & Thoracic Institute website, and patients are also encouraged to express their location preference while still in the hospital recovering prior to their discharge, as individuals may stop by the room during the phase one cardiac rehab process to discuss the importance of that next step, phase two, cardiac rehab in the outpatient setting.

Phase three, cardiac rehab is known to occur at the transition from when patients conclude or graduate from their 36 session center-based phase two cardiac rehab plan. We can also consider phase three cardiac rehab as a maintenance phase where individuals should have a recent familiarity with how to exercise safely according to the cardiac rehab individualized treatment plan guidelines for exercise intensity, duration, and modality, and patients should be comfortable during this period of time to self-supervise their exercise without the need for any wireless chest monitoring or any direct supervision.

Phase three cardiac rehab can technically occur at any local commercial gym, home-based gym, or anywhere that patients have access to. However, we encourage individuals during the phase three or maintenance phase of cardiac rehab to view it as an indefinite period where not only are they continuing to perform their heart healthy aerobic-based exercise, but they're also continuing to practice the cardiac rehab principles involving the other heart healthy risk factor components involving prevention or management of high blood pressure, the prevention or management of high lipids, prevention or management of type II diabetes and practicing weight management. Individuals if they continue to experience mental health concerns, we always are advocates and encourage individuals to continue to seek care from qualified health professionals for assistance on strategies and coping mechanisms because this is an important part of their healthcare.

We encourage you to visit our website and give one of our locations a call and discuss whether cardiac rehab is something that you should have started at this time. We hope to see you and help you achieve your heart healthy goals at one of our locations. Thank you again for joining us. And we here at Cleveland Clinic are available to support you and starting, adhering, and completing your cardiac rehab plan. Please contact us with questions or to schedule a phase two cardiac rehab consultation.


Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/LoveYourHeartpodcast.

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Love Your Heart

A Cleveland Clinic podcast to help you learn more about heart and vascular disease and conditions affecting your chest. We explore prevention, diagnostic tests, medical and surgical treatments, new innovations and more. 

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