Unstable angina / non ST elevation myocardial infarction cardiac rehabilitation


 * Associate Editor-In-Chief: Smita Kohli, M.D.

Definition
The U.S. Public Health Service definition of cardiac rehabilitation states that: Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. These programs are designed to limit physiological and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients.

Mechanism of Benefit
Cardiac rehabilitation, also called cardiac rehab(CR), is a medically supervised program to help cardiac patients recover quickly and improve their overall well being.
 * Cardiac rehabilitation programs are designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients.
 * Cardiac rehab may occur in a variety of settings, including medically supervised groups in a hospital, physician’s office, or community facility.
 * Education and counseling concerning risk factor modification are individualized, and close communication between the treating physician and cardiac rehabilitation team may promote long-term behavioral change.

Clinical trial data

 * A randomized clinical trial of cardiac rehabilitation following MI by Witt et al found that participants in cardiac rehab programs had a lower risk of death and recurrent MI at 3 years. In this study, half of the eligible patients participated in cardiac rehabilitation after MI, although women and older adult patients were less likely to participate, independent of other characteristics. Study, however, did not show any beneficial effect on recurrence of nonfatal MI.
 * Another study by Wenger et al demonstrated that cardiac rehabilitation comprising exercise training and education, counseling, and behavioral interventions yielded improvements in exercise tolerance with no significant cardiovascular complications, improvements in symptoms (decreased anginal pain and improved symptoms of HF such as shortness of breath and fatigue), and improvements in blood lipid levels; reduced cigarette smoking in conjunction with a smoking cessation program; decreased stress; and improved psychosocial well-being.
 * Other studies have also shown reduction in total cholesterol, LDL-C and HDL-C as well.
 * Studies have shown that fewer than one third of patients with MI receive information or counseling about cardiac rehabilitation before being discharged from the hospital. Physician referral is the most powerful predictor of patient participation in a cardiac rehabilitation program.

Reasons for non-participation and non-compliance
Physician referral is the most powerful predictor of patient participation in a cardiac rehabilitation program.
 * Affordability of service,
 * Insurance coverage/ noncoverage,
 * Social support from a spouse or other caregiver,
 * Gender-specific attitudes,
 * Patient-specific internal factors such as anxiety or poor motivation, and
 * Logistical and financial constraints, or a combination of these factors.

==ACC / AHA Guidelines (DO NOT EDIT) ==

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Class I
1. Cardiac rehabilitation / secondary prevention programs, when available, are recommended for patients with UA / NSTEMI, particularly those with multiple modifiable risk factors and those moderate to high risk patients who supervised or monitored exercise training is warranted. (Level of Evidence: B)}}