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Cardiac Rehabilitation

Best Medicine for your patients with Coronary Artery Disease Why you should write the Prescription TODAY!

Rev Sep 2003

Mission of Cardiac Rehab


To restore and maintain an individuals optimal physiological, psychological, social and vocational status.

Goals of Cardiac Rehab


Identify, modify, and manage risk factors to reduce disability/morbidity & mortality Improve functional capacity Alleviate/lessen activity related symptoms Educate patients about the management of heart disease Improve quality of life

Core Program Components

Risk factor management Baseline & ongoing patient assessment Exercise/activity training

What is Cardiac Rehabilitation?


Medically supervised Lifestyle modification Monitored progressive exercise/activity Inpatient-Outpatient-Maintenance (Phase I, II, III) Individualized, typically 3x/week, up to 12 weeks Physician Referral Required

Disease Management Components


Population Identification processes Evidence-based practice guidelines Collaborative practice models Patient self-management education Process and outcomes measurement, evaluation, and management Routine reporting/feedback loop

What Diagnoses are Covered?


Medicare Guidelines: Stable Angina
Myocardial Infarction Coronary Artery Bypass Graft

Private insurance coverage may vary

Utilization Benefits:

Reduced risk of fatal MI (<25%).


Decreased severity of angina & need for anti-angina meds. Decreased hospitalizations. Decreased cost of physician office visits & hospitalizations (<35%). Fewer ER visits.

Physician Benefits:
Partnership in case management provides:
Enhanced access to physician services Consistent surveillance for improved clinical outcomes Improved patient satisfaction Patient education for self directed care Feedback on medications, exercise response and other appropriate issues

Patient Benefits:
Improved functional capacity Increased knowledge of heart disease Improved adherence to positive lifestyle changes Better compliance with medical regime Increased self-esteem and confidence Reduced subsequent morbidity & mortality r/t CAD

Lifestyle Benefits:
Risk Factor and Lifestyle Modification Smoking cessation Lipid improvement Blood pressure control Exercise guidance Weight management Diabetes control Stress management

Significant Statistics

Cardiovascular disease accounts for almost 50% of all deaths in the U.S.

Cardiovascular disease affects 13.5 million Americans each year


Nearly 1.5 million Americans sustain myocardial infarctions each year
American Heart Association, Dallas Texas

Utilization Trends

Nearly 12.5 million Americans are eligible for cardiac rehab (secondary prevention) On average only 15% of these eligible candidates receive cardiac rehabilitation ranges between 11% and 30% depending on the area of the country

Risk Factors

Tobacco Smoking and Chew 50% decreased risk of CHD 1 year after cessation
Hypertension 90% middle-aged Americans will develop HTN 35 million office visits/yr for HTN

Risk Factors

Hyperlipidemia 105,000,000 people with a tot chol > 200 10% reduction in TC = 30% reduction in incidence of CAD
Physical Inactivity $76 billion > 60% of Americans dont get sufficient exercise

Risk Factors

Obesity More than 50% women and 60% men are overweight or obese Nearly 300,000 American adults die of causes related to obesity
Diabetes 58% reduction by lifestyle intervention 75% of people w/DM die of CAD or vascular disease

Exercise Research

Direct relation between inactivity and cardiovascular mortality. Inactivity is an independent risk factor for of CAD. Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for CAD.
Physical fitness has been clearly associated with improvements in lipid profiles.

Medical Research
Cardiac Rehab Professionals remain educated on the latest medical research New information is presented to your patients, so they can make informed decisions with you, their physician

Cost-effectiveness/ Cost-efficiency
Medicare payments in hospital for CVD in 1997 was $26.9 billion! Studies, adjusted for quality of life, show savings of $4,950-$9,200 per year of life saved. Reduction in re-hospitalizations and medical costs are well documented.

Cardiac Rehab Professionals


Partners in Patient Care: Medical Director Referring Physician Registered Nurses Exercise Physiologists Dieticians/Nutritionists Social Services/Psychosocial Pharmacists

Who can Refer a Patient?


Site-specific Policy:

Cardiologist Primary Care Physician Internist

Communication with Rehab?


Collaborative Approach: Initial referral/plan of care

Periodic Progress reports


Program oversight by Medical Director Open ended lines of communication

Cardiac Rehab adds Value

Cardiac patients have many disease processes and lifestyle concerns that have contributed to their heart disease.
Cardiac rehab serves the needs of each cardiac patient and works toward secondary prevention. Cardiac rehab adds VALUE to your patient care and increases QUALITY OF LIFE!

CARDIAC REHABILITATION:
A REFERRAL IS A PHONE CALL AWAY!