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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

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Center vs Home Based Cardiac Rehabilitation: Post Myocardial Infarction

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  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.

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