1 / 20

Center vs Home Based Cardiac Rehabilitation: Post Myocardial Infarction

Center vs Home Based Cardiac Rehabilitation: Post Myocardial Infarction. Presented By: Sarah Borders, Keri Howard, Justin Klenke , Conner Zuber. Introduction. Cardiac Rehabilitation Improve Physical Health Decreased Morbidity and Mortality 20% reduction in all cause mortality

ori-dale
Download Presentation

Center vs Home Based Cardiac Rehabilitation: Post Myocardial Infarction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Center vs Home Based Cardiac Rehabilitation: Post Myocardial Infarction Presented By: Sarah Borders, Keri Howard, Justin Klenke, Conner Zuber

  2. Introduction • Cardiac Rehabilitation • Improve Physical Health • Decreased Morbidity and Mortality • 20% reduction in all cause mortality • 27% in cardiac mortality at 2-5 years • (Dalal, 2010)

  3. Introduction • Cardiac Rehabilitation • 3 year survival rate of participants vs non-pariticipants • Improves prognosis post-MI in cost effective manner • Participation increases long term compliance • Positively affects the basic pathophysiology of CAD and underlying causes • (Williams, 2006)

  4. Introduction • Cardiac Rehabilitation • Significant increases in: • VO2 • 6 Minute Walk Test • Anaerobic Threshold • Positive gains seen in patients with congestive heart failure, etc. • (van Tol, 2006)

  5. Introduction • Primary Goals of Cardiac Rehabilitation • Develop individualized therapuetic plan • Aim of regaining/maintaining optimal status • Components • Home vs Center Based • (Piotrowixz,2008) http://www.sabethahospital.com/pictures/content/31817.jpg

  6. Role of Physical Therapist • Minimally involved • 1960s: Physical Therapist considered “Exercise Specialist” • 1980s: exercise physiology increases in population • Now: small amount of PT’s specialize in Cardiopulmonary fields • Require special training to become program director • Definition of PT training • (William,2008)

  7. Center-Based Cardiac Rehabilitation • Supervised group program undertaken in hospital or community setting • (Dalal, 2010) • Pro’s • Con’s http://www.harthosp.org/Portals/1/Images/21/cardiac_rehab_home.png

  8. Home-Based Cardiac Rehabilitation • Structured program with clear objectives • Completed in patient’s home • Must include PT/Physician monitoring • (Dalal, 2010) • Pro’s • Con’s http://www.cantonmercy.org/uploads/Image/cardiac_mainimage.jpg

  9. Center-Based Research • Combined leg ergometry and circuit training • 6 week program • Intensity and duration increased at week 3 • Participants completed a home exercise program • (Leitch,1997)

  10. Center-Based Research • 40 total sessions during a 5 week period • stretching and flexibility exercises • endurance training • (Marchionni, 2003) • Hospital based setting • Comprehensive cardiac rehab programmes • (Jolly, 2003)

  11. Home-Based Research • Walking program (considered control group) • (Leitch, 1997) • Received similar exercise prescription as the center-based participants • (Marchionni, 2003)

  12. Home-Based Research • Given a manual, telephone contact, and home visits • Heart manual program for first 6 weeks post MI • Home visits at 1-2 weeks, 6 and 12 weeks • Telephone contact at 3 weeks • (Jolly, 2003)

  13. Results • Peak oxygen and endurance increased in the exercise groups. (Leitch, 1997) • Home and center based showed similar improvements in: • Exercise capacity • Systolic blood pressure and serum cholesterol • Reduced hospital admits and increased QOL (home heart manual only) • (Jolly, 2003)

  14. Results • Improvements in both settings continued: • Total work capacity (TWC) • Exercise tolerance • Heart related quality of life (HRQL) • Home based • Cost saving and better permanent changes in lifestyle • Higher drop out rates • (Marchionni, 2003)

  15. Results • Exercise capacity • Short term showed no difference • Long term showed better results with home based • (Dalal, 2010)

  16. Exercise Capacity Comparisio (Dalal, 2010)

  17. Patient Preference (Dalal, 2010)

  18. Further Benefits for Cardiac Rehab (Arthur,2002)

  19. Conclusion • Any exercise is better than nothing • Positive physical benefits similar in both settings • Programs must be patient specific • Questions? • Cardiac Rehabilitation

  20. References •  Arthur H, Smith K, Kodis J, McKelvie R. A controlled trial of hospital versus home-based exercise in cardiac patients. / Comparaison lors d ' une etude controlee d ' exercices pratiques a domicile et d ' exercices pratiques a l ' hopital chez des patients cardiaques.Medicine & Science In Sports & Exercise [serial online]. October 2002;34(10):1544-1550. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed November 22, 2013. • Dalal H, Zawada A, Jolly K, Moxham T, Taylor R. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ (Clinical Research Ed.) [serial online]. January 19, 2010;340:b5631. Available from: MEDLINE, Ipswich, MA. Accessed November 10, 2013. • Jolly K, Lip G, Stevens A, et al. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]. BMC Cardiovascular Disorders [serial online]. September 10, 2003;3:10. Available from: MEDLINE, Ipswich, MA. Accessed November 10, 2013. • Leitch J, Newling R, Basta M, Inder K, Dear K, Fletcher P. Randomized trial of a hospital-based exercise training program after acute myocardial infarction: cardiac autonomic effects. Journal Of The American College Of Cardiology [serial online]. May 1997;29(6):1263-1268. Available from: MEDLINE, Ipswich, MA. Accessed November 10, 2013. • Marchionni N, Fattirolli F, Masotti G, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial.Circulation [serial online]. May 6, 2003;107(17):2201-2206. Available from: CINAHL, Ipswich, MA. Accessed November 10, 2013. • Piotrowicz R, Wolszakiewicz J. Cardiac rehabilitation following myocardial infarction. Cardiology Journal [serial online]. 2008;15(5):481-487. Available from: MEDLINE, Ipswich, MA. Accessed November 10, 2013. • Piotrowicz R, Wolszakiewicz J. Cardiac rehabilitation following myocardial infarction. Cardiology Journal [serial online]. 2008;15(5):481-487. Available from: MEDLINE, Ipswich, MA. Accessed November 10, 2013. • van Tol B, Huijsmans R, Kroon D, Schothorst M, Kwakkel G. Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. European Journal Of Heart Failure [serial online]. December 2006;8(8):841-850. Available from: MEDLINE, Ipswich, MA. Accessed November 17, 2013. • Williams M, Ades P, Squires R, et al. Clinical evidence for a health benefit from cardiac rehabilitation: an update. American Heart Journal [serial online]. November 2006;152(5):835-841. Available from: MEDLINE, Ipswich, MA. Accessed November 17, 2013.

More Related