Cardiac Rehabilitation

Why is Cardiac Rehab needed?

  • South Asians have a four times greater risk of heart disease than other ethnic groups.
  • More than half of all South Asians who suffer heart attacks get them before age 50.
  • India is fast emerging as the global capital of diabetes and Cardiovascular disease (CVD)
  • CVD affects all strata-the middle and lower middle-income groups and rural areas as much as the urban rich.
  • In Tamil Nadu, the crude mortality death rate due to CVD is highest in the country at 360-430/100,000.
  • Diabetes and CVD occur in adults during their most productive years, causing an indirect economic loss. Prevention of these diseases must be emphasized.
  • A WHO study puts the loss to the national income due to CVD at USD 7 billion in 2015.
  • By 2020, about one third of all deaths will be caused due to CHD. Sadly, most of them will be dying at a very young age.

An ounce of prevention is worth a pound of cure.

  • Most cardiac care in India is focused during a heart attack.
  • Preventive cardiac care (taking precautions to prevent heart attacks and decreasing an individual’s lifetime cardiac risk).
  • Post heart attack care including Cardiac Rehabilitation, to help the patient get back to his/her baseline, are hugely lacking in the current medical environment.
    • Lack of reimbursement
    • Not a glamorous field

Benefits of Cardiac Rehabilitation: Impact on Mortality, Hospitalizations and Risk Factors

Overall impact of exercise

  • Favorable impact on risk factors
    • Lipids
    • Blood pressure
    • Body weight
    • Insulin sensitivity
  • Enhanced parasympathetic tone
  • Improved endothelial function
  • Lower catecholamine levels with exercise may reduce platelet aggregation
  • Decrease in systolic and diastolic BP
  • Increased rates of smoking cessation
  • Increased rates of weight reduction
  • Exercise and platelets: An increase in platelet aggregation can occur after exercise in sedentary individuals (possibly related to increased catecholamines)
  • After 12 week exercise training program, platelet aggregation decreased by 52% in a study of middle age, hypertensive male subjects

Summary: How does Cardiac Rehab help? Benefits of Exercise-Based Cardiac Programs

  • 30% decrease in mortality in patients with CAD (Decrease in mortality also reported in CHF)
  • Decrease in hospitalizations after coronary revascularization and with CHF
  • Improved exercise tolerance in patients with claudication and PAD
  • Favorable impact on risk factors

Guiding principles of our clinics

  • Patient centered care
  • Standardised protocols
  • Multidisciplinary approach including GP and cardiologist, dietician, physiotherapists, personal trainers, MH specialists, pharmacist
  • Well trained personnel (including inhouse training programme)
  • Medical emergency team/crash cart, CPR trained personnel

Multidisciplinary Team

  • Cardiac Rehab Specialist
  • Cardiologist
  • Dietician
  • Physiotherapists
  • Personal trainers
  • MH specialists
  • Pharmacist
  • Well trained Cardiac tech/nurse

Eligible Patients

  • All patients need to be evaluated by a cardiologist before entry into the Rehab programme.
  • Acute coronary syndromes including h/o STEMI, NSTEMI, exercise induced angina
  • Complicated MI with LV dysfunction, recurrent infarctions, electrical disturbances, heart failure, thromboembolism
  • NYHA Class II to IV
  • s/p coronary or peripheral vascular interventions
  • Moderate stenotic valvular disease, including aortic and mitral valve stenosis(pre and post TAVI)
  • Patients with implanted cardiac defibrillator or pacemaker
  • Patients with severe LV dysfunction (EF < 30%)
  • s/p heart transplant
  • Atleast one coronary vessel with atleast 70% occlusion with no intervention
  • PVD following failed revascularisation or patients not suitable for surgical intervention and needing conservative management of claudication.

Clinical Set-up

  • Consultation rooms
  • Lab, xray, echo, TMT
  • Tilt table and holter
  • Ambulatory Bp monitor
  • Physiotherapy rooms
  • Gymnasium specially modified for cardiovascular rehab-attached telemetry
  • Exercise classes for cardiac patients
  • Medical emergency team and setup
  • Gymnasium specially modified for cardiovascular rehab-attached telemetry
  • Reticulated oxygen and suction
  • Telemetry
  • 6 minute walk test area
  • Exercise equipment including treadmill, elliptical, bikes, arm ergometer, weights area
  • Specific graded group exercise classes

Exercise protocols

  • Shortened monitored outpatient program
    • 3 days/week for up to 4 weeks
  • Monitored outpatient program
    • 3 days/week for up to 12 weeks
  • Extended outpatient program (after monitored or modified program)
    • 3 days/week for up to 4 months
  • Maintenance program (after extended program)
    • 2 days/week (Must complete the monitored out-patient program to enroll in this program)

Group exercises

  • Low patient to instructor ratio
  • Closely monitored
  • Inhouse physician
  • Group classes listed seperately for moderate risk and high risk patients
  • Combination of exercises that work on aerobic activity, coordination, strength and flexibility
  • Yoga, dance, tai-chi, aerobics. Addition of aquatherapy when pool available

Patient education

  • Cardiac anatomy and physiology
  • Symptoms to be aware of
  • Diet and exercise
  • Risk factor management
  • Psycho-social help
  • Multiple medication management
  • Sexual dysfunction

Health Information