Practice News / Events

Cardiac Rehabilitation: Practicing Prevention
By Sarah H. Wilson
Cardiac Fitness Clinic Coordinator, ACSM Exercise Specialist Certified

“…We are dedicated to the prevention, diagnosis and treatment of heart disease throughout communities in our state.”

As our mission statement reflects, Heart Clinic Arkansas puts great emphasis not only in the diagnosis and treatment of heart disease, but in the prevention as well.

Cardiac Rehabilitation has long been viewed as secondary prevention which consists of comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. Cardiac Rehabilitation programs are designed to limit the physiologic and psychological effects of cardiac illness, reduce the risk of sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients. It is our aim to reduce subsequent cardiovascular-related morbidity and mortality.

Cardiac Rehabilitation developed in the 1950’s from the concept of early mobilization after acute myocardial infarction. The standard of care prior to Cardiac Rehabilitation was bed rest and inactivity. In the 1970’s, Cardiac Rehabilitation developed into highly structured, physician supervised, electrocardiographically-monitored exercise programs. However, the programs consisted almost solely of exercise alone. Over subsequent years, Cardiac Rehabilitation has broadened beyond exercise into a composite of cardiac risk modification. Lipid, blood pressure and stress reductions, smoking cessation, diet change and weight loss are now coupled with goals of exercise training.

Cardiac Rehabilitation is divided into three phases, all of which are offered at our Kanis Road location. Phase I refers to inpatient services during hospitalization. Phase II refers to outpatient medically supervised programs that are typically initiated 1-3 weeks after hospital discharge and provide appropriate ECG monitoring. Phase III refers to maintenance programs without physician supervision and limited monitoring.

The current Medicare national coverage decision limits coverage to only phase II Cardiac Rehabilitation for those patients who in the past 12 months have had: 1) acute myocardial infarction, 2) coronary artery bypass surgery, 3) stable angina pectoris, 4) heart valve repair or replacement, 5) percutaneous transluminal coronary angioplasty (PTCA) or stent procedure, and 6) heart or heart/lung transplant. In addition to these diagnoses, most private insurance companies also provide coverage for congestive heart failure.

The Cardiac Fitness Clinic offers a multidisciplinary approach to risk reduction. Staffed by registered nurses, exercise physiologists and dietitians, we are best able to meet the needs of the “whole” patient. We realize that the effects of heart disease are not only physical, but emotional, social and vocational as well. In keeping with the goal of secondary prevention, patients and family members are encouraged to attend weekly group education sessions on:

· Development of Heart Disease
· Risk Factors
· Dining Out
· Exercise Guidelines
· Stress Management
· Cooking Demonstration
· Medications
· Emotional Changes
· Label Reading
· Angina vs. MI
· CPR
· Heart Healthy Diet

Our registered dietitian also provides our diabetic patients a 6-part Diabetes Education series including: 1) What is Diabetes?, 2) Diabetes & Heart Disease, 3) Monitoring Blood Glucose, A1c, Blood Pressure & Lipids, 4) Diabetes Medications, 5) Healthy Diabetes Lifestyle and 6) Goals of Care & Sick Day Rules.

In August 2005, the Heart Clinic Arkansas Cardiac Fitness Clinic became nationally accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Currently, Arkansas has 37 Cardiac Rehabilitation programs, and only 6 meet the strict standards for such recognition. In our 3 years of operation, our program has served over 550 phase II patients and maintained 97% overall patient satisfaction.

Our patients have testified: “I felt much more secure & positive attending the Cardiac Fitness Clinic”; “This has been a wonderful experience – very educational as well as reassuring. I will always be grateful for these past 12 weeks.”; “This is the best thing. Everyone should do it.”; “I feel much stronger & this program has helped me tremendously. The staff has been exceptionally caring. The educational information I plan to share with others.”

In looking at behavior change, on average, our patients reduce tobacco use by 62% and depression by 19%. Diet habits and diet adherence improve by 7 & 22%, respectively. Participation in regular exercise increases by an amazing 459%. Clinically, our patients reduce Hemoglobin A1c by 14%, fasting blood glucose by 16%, body fat by 3%, waist circumference by 2%, and systolic & diastolic BP by 5 & 8%, respectively. In lipid management, total cholesterol decreases by 8%, LDL by 12%, Triglycerides by 10% and HDL increases by 3%. Our patients report a 48% increase in their tolerance of daily living activities. Quality of Life indicators, on average, reveal increases of 15% in physical functioning, 10% in emotional functioning, 20% in social functioning, 6% in general health, 18% in vitality and 9% in mental health.

Cardiac Rehabilitation should be considered standard care for the patients mentioned above. Our outcomes and testimonials speak for themselves. For more information on our services, you may contact our staff by phoning 501-255-6198 or 501-255-6000