Welcome to Talking All Things Cardio Pulm. I am your host, Dr. Rachele Burriesci, physical therapist and board certified cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions, research current trends, expert opinions, and patient experiences.
The goal is to learn, inspire, and bring cardiopulm to the forefront of conversation. Thanks for joining me today, and let's get after it.
Hello, hello and welcome to episode four of Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci. So today we're gonna talk about all things cardiac rehab. Earlier today I had a mentoring session and the topic today was cardiac rehab. So we worked our way through phase one to phase four, and just talked about the structure.
The intensity levels and basically the progression from phase one to phase four. And we also talked about home-based cardiac rehab and what that looked like. And so we'll touch about, we'll touch on that a little bit today. I actually have someone in mind who I wanna bring on for, um, the home base talk.
Um, someone who also works at the VA and is still running it and I know is super passionate about it. Um, but I was totally in my fields because as I was teaching about cardiac rehab, . Um, I really just was thinking about the program that I ran. So in Michigan at the va, I. outpatient cardiac rehab, and then helped develop a home-based telehealth program.
So I've had a lot of experience in cardiac rehab and I absolutely loved running those programs. They each had something different to offer, and the patients that came into each were just a little bit different. And the way that you run cardiac rehab was just. A little bit more structured in the center-based program.
The outpatient program in-house versus the telehealth program was ultra individualized, so it just had a very different feel. Our cardiac rehab that was outpatient, um, was a group setting. . So let's say Monday and Wednesdays was cardiac rehab. We had a group of eight and four hour group of eight. We had two healthcare professionals, one pt, and one exercise physiologist.
The PT department actually ran the physical aspect of cardiac pulmonary rehab as well as the home base program. So very much had ownership of this program. I learned all the ins and outs. and I really hold it near and dear to my heart because. , the benefit is just so overwhelming. And to watch the progress of your patients from and in.
In my case, I was able to see them potentially in the I C U, just post-surgery through their movement, through the acute care system, do their pre-op education, move them to discharge to wherever they're going, and then do their pre cardiac rehab eval, post-cardiac rehab eval, see them through that whole process.
and just being able to watch the progression from. Ambulating hundreds of feet in the I C U or out, you know, the acute care setting enough to be able to discharge to home, and then how well they're able to increase their aerobic capacity post cardiac rehab. And get back to their regular life, get back to working at the factory and whatever other goals that they have.
So this is what I really wanted to talk about today. One, I wanted to talk a little bit about the structure of cardiac rehab and the benefits, but really make a point that cardiac rehab is overwhelmingly underutilized, which is. A phenomenal thought because Medicare approves 36 sessions for patients who have approved diagnoses.
So that is a lower barrier to entry already having acceptance from Medicare. But national average, and this percentage is a few years old, is only around 19 to 34% at best for people who have an eligible diagnosis that actually go through. cardiac rehab. So we need to do better. We need to get these patients through cardiac rehab.
We have to lower the barrier to entry, and that might also include thinking about home-based programs. So let's just kind of start at the top. And talk about the approved diagnoses. It is not an extensive list. Um, and I do have some harp about some of it, but this is what it is. Acute post MI has to be within 12 months of MI to be approved for cardiac rehab.
Stable angina. Unstable is a contraindication to cardiac rehab post cabbage, so post coronary artery bypass graft surgery, post heart valve repair, or replacement post P T C A, so any sort of stenting procedure, post heart transplant, or heart lung combo transplant, compensated heart failure. With the caveat of heart failure with reduced EF less than 35%.
I have a big trigger there, so I'm gonna hold that one. And then symptomatic peripheral arterial disease, which is a newer diagnosis in the approved diagnosis, but it is one that is still not necessarily approved from a Medicare standpoint. So that one can be a little. . So I'm gonna harp for a second on the heart failure.
I think this is a disservice. I think waiting until we have a reduced EF of 35% is waiting too long. I think we need to be more PREA proactive. Our patients with heart failure have known readmission rates and increase healthcare costs, and, uh, is a burden to the healthcare. . If we could get these patients in earlier sooner, maybe we can prevent some of that.
And then the other part of it is technically diastolic heart failure is not included. So patients with heart failure with preserved EF isn't an approved diagnos. And most of the research in the world of heart failures tends to lean towards reduced ef. , but it is getting better and diastolic heart failure with preserve d EF is being looked at more closely and a lot of the same parallels exist.
So even though their EF is stable, they are still in a heart failure state and can benefit from all of the same things that our reduced EF patients. . So that is one thing that I think could also be improved. But other than that, I mean, when patients are able to get to a cardiac rehab program and go through the whole program, the benefits are overwhelming.
So I'm just gonna kind of go through a list. Reduced hospitalization, reduced depression. We know depression is a very common sequelae of events. Post heart disease, post heart surgery, post mi, um, it helps decrease recurrence of acute coronary syndrome. It helps decrease overall disability, decrease modifiable risk factors.
This is the bread and butter of cardiac rehab. The whole point is to assess cardiac risk factors and target. Those risk factors by providing education, providing exercise routine, and helping create a lifestyle or behavior change that is long lasting. Because of this, we end up with improve aerobic capacity, improved quality of life.
Um, another caveat to education is improve medication adherence, which tends to help prevent progression, readmission, all of those good things. And this is the big one. Reduce mortality and morbidity, reduce recurrent of non-fatal MIS by 31%, reduce five-year mortality by 25 to 46% post cardiac rehab. That is huge.
That's what we need to push. The benefits are overwhelming and it upsets me that this is still an underutilized. Program. So there are barriers obviously, because if it was so easy to do cardiac rehab, then everyone would be going, right? So there are known barriers. One is distance. Distance to the nearest cardiac rehab facility.
This is a very common problem, especially for patients in more rural area areas. My New York just fell out areas and.
they're not everywhere. So depending on your location or your insurance, depends on how you can access. Cardiac rehab. So a lot of my background comes from the VA system. So we had patients who, for instance, came to our VA from four and a half hours away. We were the primary cardiac rehab center. We were the primary cardiac surgery center.
So that is a clear barrier, right? You can't get to cardiac rehab two to three times a week for 12 weeks at least. Driving four and a half hours to and from. So distance, location is a huge factor. Lack of transportation and not just because of a four and a half hour commute, but potentially because our patient isn't able to, um, actually drive for whatever reason or doesn't have access to a car or relies on public transportation.
Lack of transportation can be a huge barrier. Um, lack of insurance, if we're talking about the private sector and you are not a patient that has Medicare, well, insurance coverage can be a barrier. The cost of travel, the cost of a copay, financial concerns, period, is a barrier. Lack of referral. This, to me feels unacceptable.
If your patient has one of these known diagnoses, we should be educating in-house, in hospital, during their acute stay to help get them to that next step. And most facilities, especially the larger facilities, I think are very good about doing this and it's part of the plan of care while the patient is in house.
There is a lot of research that states if you can pin down a cardiac rehab location, before they discharge home, there is more likelihood that those patients will actually follow through with going to cardiac. . So referral should not be on this list. We should be referring our patients. And if you are seeing patients in the acute care setting and their post cabbage, post mi, have p a D have a heart failure exacerbation, start talking to them about cardiac rehab and its benefits and talk to your social workers.
Talk with your physician teams, get involved. This is something that should be standard of. And we need to get better access for our patients for this profoundly beneficial rehab program. That kind of goes into the next piece is education on the program. If patients don't know what cardiac rehab is, what it entails, what is involved on their part, they're not gonna get buy-in.
So if you are part of a physical therapy team who are, who is seeing patients that are post cabbage, post mi, In the hospital setting, you are part of this. You have to be educating, educate your patient on lifestyle change, behavior change, incorporating exercise, creating a home exercise program that's gonna help carry over from the acute care setting.
To home two, phase two, cardiac rehab. We need to be involved in education. If we're not educating our patients, we are doing a disservice to our patients. So we need to, we need to be involved. We need to be in, be an advocate and really push for these programs that exist. Um, . The other side of it is if the patient is referred, if the patient has access to the location, adherence to the program, once they start, there is a high percentage of dropout of cardiac rehab.
And if you are. Dropping out. It is dose dependent. So if you don't complete the full 36 sessions, then you're not gonna get max benefit to decrease mortality, morbidity, and all that good stuff because you haven't made a lifestyle change most likely. Um, depression is also part of barriers to cardiac rehab.
As I said, uh, depression is a huge piece post cardiac event and. , if your patient is suffering from depression, especially if it's not diagnosed or not being treated, they're gonna be less likely to participate in this type of program, especially cardiac rehab, which can be more social, um, group type activity.
That might be a barrier. . There's also research that shows that women have less likelihood of completing a cardiac rehab program, and, and a number of reasons for this. Um, some of 'em based on what's in the literature again, is concerning, um, one of which being referral to cardiac rehab and the lack of recommendation from physicians potentially.
So if a physician isn't selling the benefits, That can be a higher barrier for participation. Also, cardiac rehab tends to be more male driven, especially in the VA setting, and that could be a barrier to part participation. And then of course, family caregiver obligations and financial concerns just like um, the others.
So, . At minimum, we need to be educating, referring, and having a plan so that we are getting access for our patients. There are gonna be other confounding variables that we can't control, but we need to do the best that we can to promote something that we know has extraordinary benefit. So I guess the question that you're probably asking is why.
Is cardiac rehab so beneficial? And the answer truly is because it is a multidisciplinary approach with education and exercise that basically targets cardiac risk factors. So everything that puts you at risk for heart disease or MI or whatever the situation that you're in. Cardiac rehab basically mirrors that to help prevent progression, and most of it is education and, um, pushing towards behavior change, lifestyle change.
And that takes time. So one of the things I do appreciate about the, um, Medicare approved time is that it's 36 sessions. So typically cardiac rehab is either two to three times a week, let's call it three times a week, um, for basically 12 to 18 weeks, right? Depending on your frequency. So that gives you some time.
Right. We know that we can't make a true behavior change in four weeks, in eight weeks. Once you start hitting that 12 week marker, you're more likely to be able to make a change that sticks. The other piece of it is, um, motivational interviewing and determining stage of change for each cardiac risk factor.
if the patient isn't ready to make a change in one of five categories, well, you know what? You're not gonna target that category. So it's very individualized to what the patient needs, and as we know, we need to individualize our care and target what needs to be targeted for our patients. The other side of it is the education component.
So the education really also mirrors cardiac risk factors. So even if you're. creating a plan to make a change in a certain piece of this puzzle, you're still educating on benefits of, okay, so education topics can include things like just understanding the process, so understanding heart disease, understanding the process that maybe got them.
Cabbage talking about atherosclerosis and how that correlates to total cholesterol and LDL and how that relates to nutrition, and so giving the education and the background behind it is super important. Understanding patho, fizz, even at a patient level is important. Educate your patients. Okay. One thing I always teach my students is when you're learning a new topic, you need to be able.
articulate information in multiple ways. One, can you articulate it to a peer? Two. Can you articulate it to a student? Three. Can you articulate it to your patient? . And then four, can you articulate it to a physician? So being able to say the same thing in multiple ways to get your point across is an important skill, especially when you're educating patients.
I always tell students and and other colleagues and residents and mentees and anyone who I'm advising, don't be afraid to teach your patients pathophys. Don't be afraid to. The medical word, but also know that you might have to break it down and then break it down again. And if it's too broken down, you might have to add a layer.
Don't be afraid to educate. Your patients will learn, and if this has been their life for 20, 30 years, I guarantee you. You will learn some from something from them as well. So education topics are important. So learning about heart disease, um, doing a medication overview and actually discussing what the purpose of each medication is.
So when you enter cardiac rehab, you typically have a medication reconciliation via the cardiologist or the the np. And you're part of that process cuz you're gonna evaluate that patient as well. And you're gonna have a list of their. And the education of meds and adherence to medication is important.
So the more times they can hear it from multiple people, the more it's gonna stick. also having a different perspective, right? So from a fee, from a PT perspective, if your patient is on a beta blocker, what does that mean from an exercise standpoint? Well, your heart rate isn't gonna increase, like someone who isn't on a beta block, beta blocker.
So we need to use an R P E. to adjust intensity versus a target heart rate. Give that education so the patient can monitor themselves when they're exercising in their home exercise program and explain that to them. Your heart rate does not respond the same way as someone who isn't on this medication, so we need to pay attention to this.
If a patient's on a beta blocker and they have diabetes, well they can have masked hypoglycemia. Super important during. exercise. So educating that patient on checking their blood sugar pre and post exercise might be part of their education. So you bring something different. So don't feel like medication overview isn't part of what you do.
Medication overview is super important, a so that you know what your patient is taking, that you can expect a particular response, but also so that you're educating your patient. what they can expect and why that medication is important. Because if, for instance, patient is on a statin and they have myalgia or myopathy, it is gonna be very easy for them to say, I don't want to take this med anymore.
Instead of them just cold Turkey, quitting that and stopped taking it and being at risk for further atherosclerosis, increased cholesterol. That would be a time to have a conversation with the doctor, with the patient about risk benefit, and maybe being able to alter the dose. So can we alter the dose? No, but it would be worth having the conversation with the physician to, to tell them that the patient is no longer taking this medication.
because of this side effect. Can you decrease the dose? Can you do on off days? These are all things that physicians will try to basically maintain that med or keep that med on board for as long as they can. So risk benefit, conversa conversation is super important. Um, communicating about how exercise benefits this overall situation, exercise activity.
how many days a week are they doing aerobic training versus strength training is part of the cardiac risk factor profile. Asking those questions and seeing if they're ready to make that change and incorporate exercise into their life and understand why they need to incorporate exercise in their life.
And a very important thing that I find that I have, um, that I'm educating quite a bit on is understanding the difference between exercise and activity and the benefit of both, but also the differences between, and that we need a tructure. Um, purposeful exercise program to make change heart healthy nutrition.
Depending on what type of, um, cardiac rehab you're in depends on who might be teaching this. So in our outpatient cardiac rehab program, we had a dietician come in and they had about two lectures on what a heart healthy diet is. Uh, learning about the dash diet, really learning how to incorporate more fruits, more vegetable.
More fiber in general, um, and just making better choices. In the Homebased Cardiac Rehab program, I was doing that education and it's really all about understanding where your patient is at, what does their diet look like now? And I'm saying diet as the food that they consume. Not that I am putting you on a diet, it's important to underst.
How they currently eat. It's important to understand what they're willing to change. It is important to understand the financial impact of having a hard, healthy diet. Um, especially at the va, our patients ha are on a specific type of income. and they might not be able to afford fresh fruits and vegetables on a daily basis.
So then you start having conversations about frozen verse can and just making better decisions, more strategic decisions, getting more protein, being more, uh, conscious of increasing the number of servings of vegetables, and then even having conversations. Um, this is something that happened quite a bit is, uh, patients starting to add.
things like V8 into their diet to increase their number of fruits and vegetables, right? The, the label says you're getting this many servings of fresh fruits and vegetables, okay? But you have to look at the sodium level, and so especially your patients with heart failure, you have to be careful. What they think is a healthy choice versus what is a healthy choice.
So having those real conversations, making concession. and meeting your patient where there is at. I know I've said this before, but this is an important thing. You cannot rebuild everything at the same time. You have to start incorporating change slowly, because if you do that, it's more likely to be sustainable and you also have to meet your patient if they're unable to afford X.
Y. Then we can't push that. We have to find another way. So having those types of conversations and education points. The one thing I loved at the va, we had a class for our patients to basically learn how to cook. So it was a free class. I think there was multiple sessions. Um, they learned how to. , like take a cutting class.
They learned how to, um, grail verse fry. They learned the differences between adding olive oil or vegetable oil or butter in their pan, just like very basic. Um, decrease the barrier to cooking a meal type sessions, and it was hands on that the patients could actually cook with somebody, which I thought was amazing and should be available.
something that I have learned here in the Midwest. If you have, um, grocery store, Hy-Vee, they have a dietician on staff, so you can actually ask that person to go grocery shopping with you and they'll teach you, um, just the little things like shopping around the edge or picking out certain types of fruits, vegetables, and they kinda work you through the whole process and it is free.
So, , that's a low barrier to entry and something that people don't utilize again. So I, I like to throw that out and tell people that is an option. Education on stress management and how stress is related to heart disease and, and ways to decrease stress and incorporating breathing exercises. Um, and just being aware that stress is part of.
The sequelae of heart disease. Smoking cessation can be an education topic if it's an applicable topic, and then diabetes management for your patients that have diabetes. And that's a really important piece because the link between diabetes and cardiac disease is astronomical. I'm gonna get the fact wrong, but I believe you have a four times higher risk of heart disease with diabetes.
So big correlation, metabolic syndrome. That whole process is very closely linked, but also having diabetes effects, how medications relate. I mentioned beta blockers, mask, hypoglycemia. The other piece is, is you're incorporating exercise and your. Increasing exercise that the patient normally maybe wasn't doing and now they also have diabetes and they're taking this insulin or a Metformin or whatever they're taking, they need to be monitoring their blood sugar or blood glucose more closely Before cardiac rehab on the inpatient side, we would check our patient's glucose before starting and we had, you know, limits.
If they were at this level, we weren't gonna start exercise. Incorporating a snack before start and then re rechecking to make sure that it's moving in the right direction or checking post exercise session to make sure they didn't drop and we don't send them home in a hypoglycemic state. Also, exercise response or hypoglycemic response to exercise can have a delay.
You can have a hypo hypoglycemic response to exercise 24 to 48 hours after exercise. So just educating your patient to be mindful. of their signs and symptoms, signs and signs and symptoms of hypoglycemia is super important. And also to note that exercise can cause that the caveat is exercise can also help decrease the amount of medication required to manage diabetes, to manage high blood pressure to manage, fill in the blank.
So making sure to give that piece of information too. You can think, well, if it's gonna cause me my blood sugar to drop, why am I gonna do this? So making sure that you're giving the full picture for your patient to understand the benefits. So there are purposeful education topics that are included in cardiac rehab that literally mirror cardiac risk factors, and that is part of it.
You have to understand what you're changing to make a change. So the education component is, And then in the inpatient or in-person outpatient cardiac rehab program, you're physically exercising. So we ran our cardiac rehab more in a group setting. , um, private sector, uh, typically leans more individualized and I think they've moved mostly fully away from the group.
Um, but it should include a number of things. There should be a warmup of at least five minutes. There should be structured aerobic exercise for at least 30 minutes in a circuit type system with a prescribed percent target heart rate. and strengthening and a cool down and learning how to incorporate this in a structured period of time is super important.
So the way you get your target re um, sorry. Your target heart rate for cardiac rehab is based on the pre symptom limited exercise stress test prior to getting into cardiac. . So if they actually have a graded exercise stress test before coming in, that patient will have reached a max exercise heart rate.
On that test, from that number, you're gonna take 60 to 80% of that heart rate, and so you'll have a range, a low end, and a high end, and throughout that aerobic activity, you're gonna keep that range. You can also use heart rate reserve that are known as the Carin. And that range is typically between 40 and 80%.
And so the difference between using heart rate reserve and just max heart rate is that you're incorporating resting heart rate into that percent. So could be a little bit more specific or give a better range for your patient if, oh, let me back up. And RPE of 11 foot, 11 to 14 is typical range for phase two cardiac.
If your patient didn't have a graded exercise stress test, they may not have been able to for whatever reason. Um, you're gonna use more of an arbitrary number of resting heart rate plus 20 to 30 during exercise. Or you can use r p 11 to 13. If your patient is on a beta blocker and their heart rate response is minimal, you're gonna use R P E versus that target heart rate anyway.
So it just depends on your person. But the point is that you are doing basically 10 minute intervals in a circuit type setting for at least 30 minutes. So you're getting definite aerobic training in that session. from a strength side of things, the goal is to do at least one set of 10 to 15 reps of eight to 10 exercises.
So think big muscle groups, think functional muscle groups, and target that, and then end with a cool down. So what you're doing is. creating a process for your patient when they're exercising without you. They're gonna do a warmup, they're gonna do aerobic training, they might do strengthening that day, and they will end with a cool down and some flexibility or stretching.
So there's a process to it, and you are literally watching your patient do this three times a week for 12 weeks. So you're moving in the world of creating a behavior change. Now, here's the key. The benefit of outpatient cardiac rehab, phase two cardiac rehab, is that it is supervised, it is monitored.
You're assessing vitals, pre posts during you have tele attached. You have trained healthcare professionals overseeing the exercise program, and you're watching it happen. So it's being done. That is the benefit, but you have to be extraordinarily. Purposeful about getting the patient to incorporate it at home.
So if the recommendation for A C S M is to perform aerobic training three to five days a week, you know they're doing three days with you. . So the goal will be to add at least one session at home after the first week, and then eventually get to two so that they have five days of aerobic training. And then from a strength perspective, the goal is two to three times a week, they're gonna be hitting that with you so you don't have to push it as hard on the H E P.
But can they do it without you? Can they incorporate it at home? What equipment do they have? Start making or start having the conversation so that when they are performing it on their own, they have a system in place. Do they have equipment? Are they gonna get g, get a gym membership? Do they need to buy bands or weights or have something in place so they can continue this process?
So for 12 weeks, usually three times a week, you know that the patient is literally performing exercise. , some cardiac rehabs will do a post graded exercise test, which is a great pre-post. Um, I didn't mention it before, but if a graded exercise test can't be performed, typically you perform a six minute walk test and then you can absolutely perform that post cardiac rehab and see the difference.
It's also really beneficial to have labs rerun, so you can see changes in hemoglobin a1c L D. You can do weight assessment, waist circumference, pre and post, basically mirroring all the cardiac risk factors and seeing if there's change. This is important to know if what we're doing is showing change, and what research says is it does.
So being able to improve those risk factors, improving quality of life, improving aerobic capacity, and really making sure that we're exercising in this target range. This is the whole point. When we exercise, we should be targeting where our heart rate response is and sticking to it and being consistent about it, and the change will happen.
Vital sign response is so important while you're performing cardiac rehab. Typically you take previs and then at least in our program, we would reassess vitals at the five minute mark of every interval. And the reason is you wanna make sure two things. Your patient isn't dropping blood pressure and having an inappropriate response or inappropriate heart rate.
And is it enough? So is it too little? Is it too much? You don't know if you're not assessing. So super important to be checking and um, really maximizing the whole process. . So really love cardiac rehab. I think there's so much benefit to it. I think it would be wonderful to have this type of program as a pre-hab because then we likely would be able to stunt some of the progress and heart disease and you know, the long-term sequelae of readmission rates and the overburdening of our healthcare.
I wanted to just quickly, um, talk about home-based cardiac rehab and like I said, this is something I'm gonna bring someone else on and we're gonna chat about this because we've both had significant experience in the home-based cardiac rehab world and it's just so beneficial. And when you're physically in it, you, you feel the change.
You can watch it. . So I was running outpatient cardiac rehab and then I helped develop the home base program. The original VA that had developed the program was in Iowa and they were trying to branch the home base programs out to as many VAs as possible, because as you can see, it's a barrier to entrance location of cardiac rehab and, um, reaching our rural veterans.
So it was a wonderful program. There was a grant behind. , it's still going on. It's doing wonderful things and it definitely needs to be in the private sector and it's getting a little bit more common, which is wonderful. Um, but there's a lot of variability in the home-based program, but what I will tell you is it's run very similarly except your patient isn't with you.
So the concept is the same. The component of education, there's the stage of change concern for each cardiac risk factor, and then there's education for exercise, nutrition, and vital sign. Um, Assessment. So our patients in the home base program, and again, I'm speaking to the program that I ran, our patients would come in for a valve, so they would be approved by the card, by the cardiologist to go into home-based rehab.
It is also a level one, a approved program for low risk cardiac patients. So the cardiac, the cardiologist, and the MP would basically pick the patients that they think would be appropriate and then, and the nurse that was working with me would evaluate and also help make that decision. There were times where we decided this would not be a good fit, um, but that looked very similar.
We did a full eval, we did a six minute walk test with these patients. Um, gait speed. Assessment of vitals, they had education binder and logging materials. So our patients literally would log their vital signs every single day. Blood pressure, heart rate, sometimes SPO two if they had an SPO two monitor wait, especially for heart failure to make sure there wasn't any fluctuation in weight gain with, uh, post-discharge.
Cause that's a very common cause of read. and then our program supplied a peddler, A pedometer, a scale. If they didn't have one available, they're a band, and I'm probably missing something and. , every patient was a little bit different. Some people had access to a gym, some people had equipment in their home.
But at minimum we would have these pieces of equipment to work with and they would have paper to basically log, and there were charts and such. So they would log their vitals daily. They would log any changes in angina and R P E with activity. They would log their exercise every day, um, and they would log their nutrition every day.
And what we know, Logging your information is that you're more aware of what you're do, what you're doing, and what foods you're consuming and what exercise you're performing. And it is part of that behavior change that I think was part of the difference between outpatient and home-based cardiac rehab.
These patients weren't coming to the facility to exercise in a monitored, supervised sort of way. They were doing it on their own with our instruction, with a prescription, with a written hand. With education on how to use everything safely, but they were physically doing it on their own for 12 weeks or more.
And. , the education was super individualized. It was already individualized on the outpatient side, but it's just one-on-one. And our program was actually phone based, so we didn't even have the video components. So working through exercises, being able to articulate yourself well enough on the phone is a high level skill that I highly recommend anyone to do.
I think it made me a better therapist just in general. , but these patients, they look forward to those calls. It was one phone call every week for 10 weeks, and then the first week was the eval, and the last week was discharged. So basically 10 weeks of calls specific to them. And the feedback that we got from, from most of our patient was they were excited for the calls.
They were sad that it was ending. They. Encouraged by their progress. They were excited to, to give the information to us. And we would literally sit on the phone and they would read us our log, their logs, and then we would discuss what could be changed, what could be improved, uh, what we need to worry about, what we can increase in intensity or time.
It was just wonderful. I loved everything about it and our patients did so good. So right before I left, um, I was starting to collect data and. This was aec, not anecdotal. It, this was not significant yet because we only had so many numbers, but we had a 70% completion rate, which was great. We had improvement in six minute walk test.
Um, we had decreased readmission rates. We were showing really good progress. The one thing I wish we could have had more consistently was, um, lab values. taken again on the post and like the timing of it, but our patients were doing great. And nationally, the research that shows is that home-based cardiac rehab does just, just as well as our outpatient in-person cardiac rehab.
There was actually one more benefit of the home-based program compared to the. Outpatient cardiac rehab at one year follow up. Our patients that were in the home-based program, were maintaining the improvements that they made, if not more than at the 12 week mark and then before, um, their pre cardiac rehab.
So our home-based patients had a better outcome at one year follow up than our outpatient cardiac rehab. And again, these were our numbers. So part of that is the ability of patients to perform the exercise on their own. From day one, they were doing the exercise, they were logging their nutrition, they were making these changes in the moment every day for 12 weeks.
So just. ownership in making change and really creating a lifestyle change was huge for our patients with home-based cardiac rehab. So the benefit is there. We just have to have the programs to access. So I hope this was helpful. I think cardiac rehab, um, is a wonderful program. It is unfortunately underutilized and I think we're part of the process.
getting more for our patients and advocating for what's best for them. So throwing that out there. I hope this was helpful. I hope we learned something about phase two cardiac rehab from both an outpatient and a home-based front. Um, if you have any questions, commentary, rebuttals, um, reach out to me through the dms on the Instagrams, or you can shoot me a text at nine one.
913-308-4494. I hope you have a wonderful rest of your day and whatever you have to do, get after it.