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BMJ publish Clinical Review of Cardiac Rehabilitation
Untitled Document BMJ Clinical Review Cardiac rehabilitation Hasnain M Dalal, Patrick Doherty & Rod S Taylor BMJ 2015;351:h5000 / http://www.bmj.com/content/351/bmj.h5000 | On the 29th September 2015, coinciding with the BACPR Conference in Manchester, the British Medical Journal published a Clinical Review of Cardiac Rehabilitation. The review features the key messages from the BACPR Standards & Core Components 2012 and examines the current evidence for Cardiac Rehabilitation highlighting that with the advances in modern treatment of cardiovascular disease the benefits of CR are found in the improvements to quality of life, rather than changing mortality itself
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The bottom lineGlobally, the prevalence of coronary heart disease and heart failure is increasing, and there is some evidence of the health benefits of cardiac rehabilitation
Effective implementation of cardiac rehabilitation after acute coronary syndrome, coronary revascularisation, and heart failure has remained suboptimal, with overall participation rates <50% over recent decades despite international recommendations
International guidelines now recommend that cardiac rehabilitation programmes include health education and psychological counselling
Patients should be offered a choice of community based and home based cardiac rehabilitation programmes to fit their needs and preferences
Clinicians should endorse cardiac rehabilitation for patients with a recent diagnosis of coronary heart disease or heart failure | The review also sets a number of challenges for CR looking to the future, which it terms the ‘Unanswered Questions’:
- What characteristics are associated with uptake and adherence to cardiac rehabilitation after an acute myocardial infarction when rehabilitation is started early?
- How can referral and participation rates for eligible patients be increased?
- Should referral be the responsibility of the physician or the healthcare team?
- How will working and non-working patients afford to pay for these services?
- Can advances in information and communication technologies be used to develop novel ways of delivering cardiac rehabilitation to improve uptake and adherence?
- How can we improve uptake in hard to reach groups, such as patients living in rural communities, patients from ethnic minority groups, and those from low socioeconomic classes?
- Is cardiac rehabilitation, as delivered in routine clinical practice, still effective? | Patient Story | The review includes a personal story from cardiac patient Phillip Boorman relating his experiences and the benefits of cardiac rehabilitation for him. | "I am a 65 year old retired air traffic controller, and had been treated for hypertension and high cholesterol since 1998. I had experienced mild chest pains in the past, which I could always walk through, but more severe pains in December 2014 led me to seek advice from my general practice, which resulted in a referral to the Fast Track Chest Pain Clinic. Ironically, while I was waiting for my outpatient appointment, I experienced a bout of more severe pain at home and was rushed to hospital, where I was told that I had had a heart attack. | Treatment in hospital was first class, and a single stent was fitted. My first contact with the cardiac rehabilitation team was a home visit by a rehabilitation nurse. She was suitably encouraging, but the cynic in me thought that she was probably encouraging to everyone. However, her advice was sound, and I followed it to the letter. Rehabilitation sessions at the gym started about eight weeks after my heart attack and not only proved to be physically demanding and rewarding (no stopping for at least 50 minutes) but also helped to rebuild my slightly flagging confidence. The programme included “teach-ins” on lifestyle, relaxation, diet, and exercise regimens, and I am extremely grateful for the opportunity to attend. | | …cardiac rehabilitation has fast-tracked me back to a normal life… | Will I have another heart attack? I don’t know, but I do know that cardiac rehabilitation has fast-tracked me back to a normal life and given me the knowledge that the chances of another heart attack are greatly reduced. It is also helpful to know that I will have regular follow up by my GP and see the practice nurse in the cardiac clinic at least once a year.” | Further discussion on the Clinical Review and its implications for practice on the BACPR Members’ Discussion Forum |
09 October 2015
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