p-ISSN:
2980-4302
e-ISSN:
2980-4310
Vol. 2 No. 9 September 2024
Improvement of Functional Capacity and Quality of Life
by Cardiac Rehabilitation: Case Series
Mohammad Risandi Priatama1*, Alfonsus
Pramudita Santoso2, Ade Meidian Ambari3
1,2,3 Pusat Jantung dan Pembuluh Darah Nasional Harapan
Kita, Indonesia
Email:
mohammad.risandi@ui.ac.id1*, alfonsuspramudita625@gmail.com2,
ade.ambari@inaprevent.org3
Cardiac rehabilitation (CR) is a long-term program involving prescribed
exercise, education, and counseling to mitigate the physiological and
psychological impacts of cardiac disease. Despite evidence supporting its
effectiveness in reducing mortality rates, CR remains underutilized,
particularly among patients with heart failure. This research aims to highlight
the importance of CR in improving the quality of life and functional capacity
for post-cardiac surgery and heart failure patients. The study involved a series
of case illustrations, including patients undergoing aortic valve replacement,
coronary artery bypass graft surgery, and congenital heart disease repair. Each
patient completed a Phase II rehabilitation program consisting of 12 exercise
sessions, with functional capacity measured using the six-minute walk test
(6MWT). The results indicated significant improvements in both functional
capacity and quality of life, including reductions in depression levels. The
findings suggest that CR is highly beneficial in enhancing patients' overall
recovery and quality of life, particularly when integrated into standard
postoperative care. Given these results, healthcare systems should promote
broader access to CR programs to maximize patient outcomes. Additionally,
future research should explore long-term benefits and develop personalized CR
programs to cater to diverse patient needs.
Keywords: Cardiac Rehabilitation, Post Cardiac
Surgery, Heart Failure, Functional Capacity, Quality of Life
INTRODUCTION
Cardiac rehabilitation (CR) services
are an integral component in the continuum of care for patients with
cardiovascular disease (CVD) (Ardiana,
2021). A Class IA recommendation, referral to CR is 1 of 9
performance measures for secondary prevention established by the American Heart
Association and American College of Cardiology after myocardial infarction
(MI), percutaneous coronary intervention, coronary artery bypass graft surgery,
in the setting of stable angina, symptomatic peripheral arterial disease (i.e.,
intermittent claudication). Referral to CR is also recommended after heart
valve surgery, cardiac transplantation, heart failure (HF). The safety and
effectiveness of the traditional medically supervised, center-based CR (CBCR)
model are well established, and CBCR is effective in reducing hospital
readmissions, secondary events, and mortality in patients with CVD (Thomas
et al., 2019).
The most recent EUROASPIRE IV survey
was undertaken in 78 centres from 24 European countries. The results of
EUROASPIRE survey showed that despite the wealth of scientific evidence only
half of patients were referred to attend a cardiac rehabilitation program and
only two-fifths participated in such a programme (Kotseva
& Investigators, 2017). Cardiac rehabilitation is underused
among patients with heart failure. There are three components that involved to
CR, patients factors (time conflicts, lack of motivation, reluctance of change
lifestyle, depression), service factors (difficulties with accessibility of
programs, little insurance coverage), physician factors (fewer referral from
cardiologists, fewer well-trained CR staff, heavy workload of doctors). Those
components affected patient fear of readmission (Chun
& Kang, 2021); (Bozkurt
et al., 2021).
Cardiac rehabilitation (CR) is a
long-term program that involves prescribed exercise, education, and counseling
to limit physiological and psychological effects of cardiac disease and to
enhance the psychosocial and vocational status of the patient (Romelah,
2021). Considering the patient’s need to obtain a full and prompt
physical recovery after surgery to allow a fast normalization of daily life
activities (Kiel,
2011); (Niebauer,
2016).
CR also has an important effect in
reducing mortality in patients with HF. According to the Exercise Training
Meta-Analysis of Trials in patients with Chronic Heart failure (ExTraMATCH)
study, the mortality rate in the CR group was reduced by 35% compared with that
in the control group during the 2-year follow-up period (Taylor
et al., 2023).
Based on the background provided, the
objectives of this research are to analyze the factors contributing to the
underutilization of cardiac rehabilitation (CR) services and to assess the
impact of CR on reducing mortality and improving patient outcomes, particularly
in patients with heart failure. Specifically, the study aims to explore
patient, service, and physician-related barriers to CR participation and to
evaluate the benefits of CR in enhancing recovery and reducing hospital
readmissions.
The benefit of this research is to
provide insights into how to increase CR participation rates by addressing the
identified barriers, improving patient recovery post-cardiovascular events, and
ultimately contributing to the reduction of mortality rates in heart failure
patients. These findings could inform healthcare policy and practice to ensure
broader access and engagement in cardiac rehabilitation programs, leading to
better long-term outcomes for patients with cardiovascular disease.
RESEARCH METHODS
Case Illustration
Case 1
A
36 year old man, came to cardiovascular rehabilitation department of Harapan
Kita hospital for cardiac consultation, evaluation and rehabilitation
post-surgery. Patient had a history of
discharge from successful of aortic valve replacement with a 25 mm SJM medical
regent two weeks prior to the consultation. Patient was diagnosed with severe
aortic regurgitation vegetation on non-coronary cusp and right coronary cusp,
mitral regurgitation mild-moderate and infective endocarditis. The patient
complained a presenting symptom of dyspnea one month prior to the admission.
The patient has a slight limitation of physical activity, he gets comfortable
at rest, and these symptoms were amplified on moderate physical activity.
There’s no fever, dental caries (+). The patient
was referred from Bhakti Asih hospital. The surgical procedure went out
successfully and straight-forward. The patient was hopitalized around one month
and then discharged from the hospital with warfarin 2 mg o.d, furosemide 40 mg
o.d prn, bisoprolol 5 mg o.d, ramipril 5 mg o.d
ECG shows Sinus rhythm, rate 67 x/min,
normoaxis, no ST or T segment changes, no
ventricular hypertrophy. Chest X-Ray shows a
Cardiothoracic ratio of less than 50%, without any signs of congestions or
infections. The latest laboratory findings, PT 16.9 s and INR 1.66
From the echocardiographic finding two
weeks after the aortic valve replacement with a 25 mm SJM medical regent
surgery, the prosthetic valve is well seated and opens well, there is trace
paravalvar leakage, normal global LV systolic function, EF 63%, global
normokinetic, eccentric LVH with diastolic dysfunction grade II, reduced RV
contractility, there is no pericardial effusion.
At the cardiovascular
rehabilitation department, the patient receives a consultation. On the initial
6 minutes walk test (telemetric), the distance was obtained 395 m. The patient
receives thorough medical evaluation following a phase II rehabilitation programme containing 12 exercise sessions. Each
session started with warm-up followed by ergo cycle, aerobic training and
cooling down step. At last 12th session, the final distance on 6
minutes walk test was 447 m with estimation METS 8.64. The patient had increased
of distance capacity during 12th session exercise. Specifically, the
patient continued to treadmill exercise in seventh session with progression on
distance. Then, the patient underwent the cardiac exercise test using treadmill
test with bruce protocol. The result is an exercise duration of 08 minutes 01 second, with a
maximum systolic blood pressure of
130/80 mmHg, maximum heart rate of 144 bpm (78% maximum HR on BB). The
test showed negative ischaemic response, the test was stopped because the patient
felt fatigue, with aerobic capacity of 8.9 METs
and duke treadmill score of +8.
Table 1. Exercise prescription for the
patient
|
Exercise Type |
Aerobic |
|
Frequency |
5-7 x/week |
|
Exercise Load (Metts/Watt) |
5.3 – 6.2 METs |
|
Exercise Heart Rate (Range) |
104 – 117
bpm |
|
Walking (km/30 min) |
2.8 – 3.2 km/30 min |
|
Cycling (km/30 min) |
6.5 – 8 km/30 min |
|
Re-evaluation |
3 – 6 Month |
|
Suggestion |
Take medications and exercise regularly |
The patient the discharged from the
cardiovascular rehabilitation programme and planned to return to the rehabilitation
department in 3 to 6 month after the last session. The
patient was encouraged to follow the exercise prescription.
Case 2
A
39 year old man, came to cardiovascular rehabilitation department of Harapan
Kita hospital for cardiac consultation, evaluation and rehabilitation post
discharge from hospital. The patient denied any cardiac symptoms, either
dyspnea or chest pain during the consultation. Patient with a history of
discharge from hospital 1 week prior to the consultation. Patient was diagnosed
with non-ischemic cardiomyopathy, suggesting left ventricular non compaction
cardiomyopathy. The patient complained of shortness of breath 1 week prior to
the admission. The complaint was accompanied with dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, chest pain, abdominal discomfort,
bloating and nausea. Pretibial oedema, fever and cough were denied. The patient was hopitalized around 1 week and then
discharged from the hospital with cedocard 5 mg o.d, concor 2.5 mg o.d,
lansoprazole 30 mg o.d, spironolactone 25 mg o.d, ubi q 100 mg t.d, rivaroxaban
15 mg o.d, allopurinol 300 mg o.d, dapaglifozin 10 mg o.d, candesartan 16 mg
o.d, theragran m o.d, lasix 40 mg b.i.d.
ECG shows Sinus rhythm, rate 88 x/min,
normoaxis, downsloping ST depression at V2-V6, no ventricular hypertrophy. Chest X-Ray shows a Cardiothoracic ratio of more than
50%, with sign of congestion (cranialization). Laboratory finding shows
elevated level of NT Pro BNP (777 pg/mL), with elevated liver enzymes (SGOT 178
U/L, SGPT 59 U/L).
From the echocardiographic examination
it was found, dilatation on LA, RA, LV, RV. LVH (+) eccentric, LVMI 184 gr/m2,
global contractility LV EF 18% (Simpson), reduced RV contractility, TAPSE 1.5
cm, regional wall motion abnormality with mild tricuspid and pulmonary
regurgitation.
At the cardiovascular
rehabilitation department, the patient receive a consultation. On the initial 6
minutes walk test (telemetric), the distance was obtained 180 m. The patient
receives thorough medical evaluation following phase II rehabilitation
programme containing 12 exercise session. Each session started with warm-up
followed by ergo cycle, aerobic training and cooling down step. The patient had increased until eight session,
continued with stagnant of walking distance capacity until 12th session
exercise, and had decreased on ergocycle intensity. At last 12th session,
the final distance on 6 minutes walk test was 358 m with estimation functional
capacity 6.9 METS. Patient is going through heart failure rehabilitation for 3
months.
Table 2. Exercise prescription for the
patient
|
Exercise Type |
Aerobic |
|
Frequency |
5-7 x/week |
|
Exercise Load (Metts/Watt) |
4.1 - 4.8 METs |
|
Exercise Heart Rate (Range) |
103-106 bpm |
|
Walking (km/30 min) |
2.4 - 2.8 km/30 min |
|
Cycling Weight Training (km/30 min) |
4.8 - 6.4 km/30 min |
|
Re-evaluation |
3 – 6 Month |
|
Suggestion |
Take medications and exercise regularly |
Case
3
A 14 year old boy, came to
cardiovascular rehabilitation department of Harapan Kita hospital for cardiac consultation,
evaluation and rehabilitation post surgery. The patient denied any cardiac
symptoms, either dyspnea or chest pain during the consultation. Patient with a
history of discharge from succesfull of tetralogy of fallot repair surgery 1
week prior to the consultation. Patient was
diagnosed with tetralogy of fallot. The patient complained hemoptysis 5 days
prior to the admission. The patient has a slight
limitation of physical activity with dyspnea on exertion. Fever, and weight
loss were denied. The surgical procedure went out successfully and
straight-forward. The patient was hopitalized around 1 week and then discharged
from the hospital with bisoprolol 1.25 o.d, ramipril 1.25 mg o.d, furosemide 40
mg o.d
ECG shows Sinus rhythm, rate 100x/min,
RAD, ST elevation at lead I and V2-V6, ST depression at V1. Chest X-Ray shows a
Cardiothoracic ratio more than 50%, without any signs of congestions or
infections.
From the echocardiographic finding two
weeks after tetralogy of fallot repair surgery, PE (+) on LV posterior dextra
9-20 mm, good LV function, EF 70%, reduced RV contractility, TAPSE 1.2 cm,
residual PS mild, PG 30 mmHg, PR mild, no residual VSD, other valves were in a
normal condition.
At the cardiovascular
rehabilitation department, the patient receives a consultation. On initial 6
minutes walk test (telemetric), the distance was obtained 300 m. The patient
receives thorough medical evaluation following a phase II rehabilitation programme
containing 12 exercise sessions. Each session started with warm-up followed by
aerobic training and a cooling down step. At last 12th session, the
final distance on 6 minutes walk test was 392 m with estimation METS 7.95. The
patient had increased of distance capacity during 12th session
exercise. Specifically, the patient continued to treadmill exercise in nine
session with progression on distance. Then, the patient underwent the cardiac
exercise test using treadmill test with bruce protocol. The result is an
exercise duration of 06 minutes 33 second, with a maximum systolic blood
pressure of 130/80 mmHg, maximum heart
rate of 150 bpm (72% maximum HR on BB). The test showed negative ischaemic
response, the test was stopped because the patient felt fatigue, with aerobic
capacity of 7.65 METs and duke treadmill score of +7.
Table 3. Exercise prescription for the
patient
|
Exercise Type |
Aerobic |
|
Frequency |
5-7 x/week |
|
Exercise Load (Metts/Watt) |
4.5-5.3 METs |
|
Exercise Heart Rate (Range) |
118-130 bpm |
|
Walking (km/30 min) |
2.4-2.8 km/30 min |
|
Re-evaluation |
3 – 6 Month |
|
Suggestion |
Take medications and exercise regularly |
The patient was discharged from the
cardiovascular rehabilitation programme and planned to return to the
rehabilitation department in 3 to 6 months after the last session. The patient
was encouraged to follow the exercise prescription and take medications
regularly.
Case 4
A 63 year old man, came to
cardiovascular rehabilitation department of Harapan Kita hospital for cardiac
consultation, evaluation and rehabilitation post surgery. The patient denied
any cardiac symptoms, either dyspnea or chest pain during the consultation.
Patient with a history of discharge from successful CABG surgery 4 days prior
to the consultation. Patient was diagnosed with CAD3VD. The patient complained
a presenting symptom of anginal chest pain 6 months prior to the admission. The
complaint was accompanied with dyspnea on exertion, slight limitation of
physical activity. The patient underwent coronary angiography and said to have
occlusion in three coronary arteries. The patient were then planned to have a
coronary artery bypass graft surgery (CABG) in
the following month. The surgical procedure went out successfully and
straight-forward. The patient was hospitalized around 1 month and then
discharged from the hospital with bisoprolol 2.5 mg o.d, ramipril 2.5 mg o.d,
atorvastatin 20 mg o.d, clopidogrel 75 mg o.d
ECG shows Sinus rhythm, rate 75 x/min,
normoaxis, ST elevation at V2-V3, no ventricular hypertrophy. Chest X-Ray shows a Cardiothoracic ratio of more than
50%, without any signs of congestions or infections. Laboratory finding shows
elevated platelets (700000 cells/mm3) and elevated FT 4
level (41.47ng/dL).
From the echocardiographic finding two weeks after the coronary
artery bypass graft surgery, good LV
systolic function, LVEF 61% (simpson’s), global normokinetic, concentric
remodeling with grade I diastolic dysfunction without increased LAP, all valves
are normal, good RV contractility.
At the cardiovascular
rehabilitation department, the patient receives a consultation. On initial 6
minutes walk test (telemetric), the distance was obtained 264 m. The patient
receives thorough medical evaluation following a phase II rehabilitation programme
containing 12 exercise sessions. Each session started with warm-up followed by
ergocycle, aerobic training and cooling down step. At last 12th session,
the final distance on 6 minutes walk test was 350 m with estimation METS 5.74.
The patient had increased of walking distance capacity until five session
exercise. Then decreased on walking distance at 6th session and got stagnant.
After that the exercise added with ergocycle training until 12th session,
because of stroke history. Then, the patient underwent the cardiac exercise
test using ergocycle protocol. The result is an
exercise duration of 08 minutes 06 second, with a maximum systolic blood
pressure of 140/80 mmHg, maximum heart
rate of 99 bpm (63 % maximum HR on BB). The test showed negative ischaemic
response, the test was stopped because the patient felt fatigue, with aerobic
capacity of 4.49 METs.
Table 4. Exercise prescription for the
patient
|
Exercise Type |
Aerobic |
|
Frequency |
5-7 x/week |
|
Exercise Load (Metts/Watt) |
2.7-3.1 METs |
|
Exercise Heart Rate (Range) |
85-90 bpm |
|
Walking (km/30 min) |
1.2-1.6 km/30 min |
|
Cycling Weight Training (watt/30 min) |
25-30 watt/30 min |
|
Re-evaluation |
3 – 6 Month |
|
Suggestion |
Take medications and exercise regularly |
The patient was discharged from the
cardiovascular rehabilitation programme and planned to return to the
rehabilitation department in 3 to 6 months after the last session. The patient
was encouraged to follow the exercise prescription and take medications
regularly.
Cardiac Rehabilitation has evolved over
the past decades from a simple monitoring for the safe return to physical
activities to a multidisciplinary approach that focuses on patient education,
individually tailored exercise training, modification of the risk factors and
the overall well-being of the cardiac patients (Firmana
& Anina, 2024). Recent research shows that CR has
functions such as mortality reduction, symptom relief, improved exercise
tolerance, and the overall psychosocial wellbeing. These interventions include
education, counseling and behavioral strategies to promote lifestyle change and
modify risk factors (Mampuya,
2012).
Indications of
Cardiac Rehabilitation
The generally accepted indications for
cardiac rehabilitation include: acute myocardial infarction, stable angina
pectoris, coronary artery bypass graft surgery, heart valve repair or
replacement, percutaneous transluminal coronary angioplasty and heart transplantation
or heart lung transplantation (Mampuya,
2012). Referred to case 1, 3 and 4 the indication of CR is after
surgical cardiac procedure (bypass, valvular, CHD, aortic, etc), on case 2 the
indication of CR is compensated heart failure (Radi et
al., 2019).
Contrandications of
Cardiac Rehabilitation
Contraindications to cardiac
rehabilitation include unstable angina, decompensated heart failure, complex
ventricular arrhythmias, pulmonary arterial hypertension greater than 60 mmHg,
intracavitary thrombus, recent thrombophlebitis with or without pulmonary
embolism, severe obstructive cardiomyopathy, severe or symptomatic aortic
stenosis, uncontrolled inflammatory or infectious pathologies and any
musculoskeletal condition that prohibits physical exercise (Radi et
al., 2019). Referred to all the case, there is no contraindication.
Benefit of Cardiac
Rehabilitation and Exercise Training
Benefits of cardiac rehabilitation and
exercise training includes improvement in exercise capacity, lipid profiles,
and quality of life. CR also has an effect on reduction in inflammation and
indices of obesity (Swain
DP, Brawner CA, 2014).
Components of Cardiac
Rehabilitation
Phase I or inpatient phase is initiated
while the patient is still in the hospital. It consists of early progressive mobilization
of the stable cardiac patient to the level of activity required to perform
simple household tasks (Mampuya,
2012).
Based on PERKI guidelines, phase
II duration program of CR is 1-3 months.
Study by Radi et al, in National Cardiovascular Care Unit Harapan Kita phase II
duration program of CR is 1-2 months. In Europe CR phase II duration program 3
to 4 weeks duration are offered. Based on AHA CR phase II duration program
12-36 weeks (Kiel,
2011); (Radi et
al., 2019).
Phase III is a lifetime maintenance
phase in which physical fitness and additional risk-factor reduction are
emphasized. It consists of home-or gymnasium- based exercise with the goal of
continuing the risk factor modification and exercise program learned during
phase II (Mampuya,
2012).
The American Heart Association, the
American College of Cardiology Foundation and the American Association of
Cardiovascular and Pulmonary Rehabilitation have outlined the core components
of contemporary cardiac rehabilitation and secondary prevention programs and
produced guidelines for detection, management and prevention of cardiovascular
disease. These core components include patient assessment, exercise training,
physical activity counseling, tobacco cessation, nutritional counseling, weight
management, aggressive coronary risk-factor management, and psychosocial
counselling (Mampuya,
2012).
a.
Patient assessment
In
order to guide the patient through the different aspects of cardiac
rehabilitation, to meet his individual needs and to optimize the benefits. The
goal is to insure a safe environment for the patient and to facilitate patient
care with minimal risk. Before the exercise training, a symptom limited
exercise test is undertaken for prognostic, diagnostic, and therapeutic
purposes (Mampuya,
2012).
b.
Exercise training
The
scientific data clearly establishes that exercise training results in
improvements in exercise tolerance. Appropriately prescribed and conducted
exercise training is therefore a key component of cardiac rehabilitation.
Meyers et al. showed that improvement of 1 metabolic equivalent in functional
capacity imparts a 12% reduction in all-cause mortality. Exercise protocols
should include not only endurance but also resistance training (treadmills,
steppers, weights, rowers, elliptical trainers, exercise bikes, dumbbells etc).
High-intensity interval aerobic exercise program and high-calorie-expenditure
exercise program are two such modalities (Mampuya,
2012).
Six
minutes walk test (the 6MWD) is a test that evaluates the global and integrated
responses of all the systems involved during exercise, including the pulmonary
and cardiovascular systems, systemic circulation, peripheral circulation,
blood, neuromuscular units, and muscle metabolism. Referred to PERKI
Guidelines, case 2 exercise is occurred on the next day because the distance is
<240 meters and case 1,3,4 exercise is directly occurred (Radi et
al., 2019).
Figure 1. Patient
Evaluation in CR
c.
Treadmill Test
Treadmill
test is ideally to make an exercise prescription because we can find out
maximal fitness level, heart rate and blood pressure. We can evaluate ischemic
and arrythmia response according to training load. In this case, treadmill test
was done in day 12th of the program to evaluate functional capacity (Radi et
al., 2019).
d. Physical
activity counseling
Regular physical
activity has been shown to have many cardiovascular benefits including weight
loss, blood pressure reduction, glycaemic control and lipid profile
improvements. Most guidelines recommend that exercise should be performed for a
minimum of 30 minutes per day at least five days per week and preferably daily,
should involve moderately intensive aerobic activity such as brisk walking and
should be supplemented by an increase in daily lifestyle activities (e.g.,
walking breaks at work and gardening) (Mampuya,
2012).
e.
Controlling the Risk Factor
Controlling the risk
factor with healthy lifestyle or drugs for achieving the target. This step
include management of nutrition, weight management, lipid, blood pressure,
blood glucose, psychosocial and tobacco cessation (Mampuya,
2012). In this case, nutritional counseling will be carried out
by nutritionist doctor.
f.
Management of Psychosocial and Professional Issues
Patients with heart
disease are often confronted with psychological and social problems that can
affect both morbidity and mortality. During cardiac rehabilitation follow-up,
patients undergo a routine screening to identify anxiety, depression, substance
abuse and familial or other social problems. Medical, psychological and social
interventions tailored to individual problems are offered and have been shown
to improve outcomes. The INTERHEART Study quite clearly demonstrated that
stress was approximately 30% of the population’s attributable risk of acute MI.
Psychosocial stress affects cardiovascular disease process through the increase
in blood pressure, blood glucose, lipid levels and body weight. It also
promotes the progression of atherosclerosis, inflammation and endothelial
dysfunction (Mampuya,
2012).
Figure 2. QoL
Evaluation Hospital Anxiety and Depression Score
Components of
Exercise Training Session (Bakker et al., 2017)
1) Warmed up: at least 5-10 minutes of
light to moderate intensity cardiorespiratory and muscular endurance activities
2) Conditioning: at least 20-60 minutes of
aerobic, resistance, neuromotor, and or sport activities
3) Cool down: at least 5-10 minutes of
light to moderate intensity cardiorespiratory and muscular endurance activities
4) Stretching: at least 10 minutes of
stretching exercise performed after the warmed up or cool down phase
Figure 3. FITT Recommendation for
Individuals with CVD
(Outpatient CR) (Swain
DP, Brawner CA, 2014)
All of the cases are in the outpatient
cardiac rehabilitation clinical setting.
Figure 4. FITT Recommendation for Individuals
with Heart Failure
(Swain
DP, Brawner CA, 2014)
Based
on case 2, the patient had history of heart failure. The program has been
followed for at least 3 months of CR.
Table 5. Cardiac
Rehabilitation Response (Bakker
et al., 2017)
|
Improvement
of Functional Capacity in 3 Months |
Rehabilitation
Response Rate |
|
>2.5
ml/kg/min |
High
Responder |
|
|
Low Responder |
|
|
Non
Responder |
Cardiac
Rehabilitation in Heart Failure
Latest guidelines recommend concomitant
drug treatment for HFrEF patients, the so-called ‘four pillars’ of heart
failure treatment (Taylor
et al., 2023). Cardiac rehabilitation is the ideal
time and place for implementation and titration of these drugs.
Cardiac
Rehabilitation in Children with CHD
Children with “repaired” CHD often have
reduced exercise capacity. Residual
hemodynamic lesions certainly account for some of this phenomenon. However, it
has been observed that children with CHD often lead relatively sedentary
lifestyles, perhaps on account of restrictions imposed on them by physicians,
parents, teachers, coaches, or the children themselves (Rhodes
et al., 2010).
Cardiac
Rehabilitation in Post CABG
CR is a comprehensive program,
integrating individualized and supervised exercise with education, both
important for patients after CABG. It acts in 2 steps: (1) CR promotes a faster
recovery from heart surgery in the first weeks after the procedure, which is
particularly important for the typical CABG patient, an elderly individual with
several comorbidities and limitations; (2) it provides healthy routines, tools,
and the knowledge necessary to manage coronary artery disease to be successful
in the long term (Niebauer,
2016). In patient after bypass surgery, we have to assess
ischemic response and repeat after 3 months for optimization of anti ischemic
therapy.
CONCLUSION
Cardiac rehabilitation (CR) has been
shown to be highly effective in various cases, including valvular surgery,
heart failure, congenital heart disease surgery, and coronary artery bypass
surgery, all of which carry a Class I A recommendation. Patients who undergo CR
demonstrate significant improvements in functional capacity, as measured by the
6-minute walk test (6MWT), and experience enhanced quality of life,
particularly in terms of reduced depression levels. Moreover, cardiac
rehabilitation is universally covered, allowing its benefits to extend beyond
surgical cases to include heart failure patients. The primary advantages of CR
include improved functional capacity, enhanced fitness levels, and an overall
better quality of life for patients with cardiovascular conditions. To further
maximize the benefits of cardiac rehabilitation, it is recommended that
healthcare systems continue to promote the universal accessibility of CR
programs, particularly for non-surgical patients, such as those with heart failure.
Future initiatives should focus on improving patient referral rates by
addressing physician-related barriers, such as workload and training, and
mitigating patient factors like lack of motivation and time constraints.
Additionally, future research could explore the long-term effects of CR on
psychological well-being and investigate the development of personalized CR
programs to meet the unique needs of different patient populations. Expanding
tele-rehabilitation and home-based CR models may also offer more flexible
options for patients, ultimately leading to increased participation and better
overall outcomes..
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Copyright holders:
Mohammad
Risandi Priatama, Alfonsus Pramudita Santoso, Ade Meidian Ambari (2024)
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AJHS - Asian Journal of Healthy and Science
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