Cardiac Rehabilitation Effectiveness

This assignment delves into the efficacy of cardiac rehabilitation programs for individuals with heart failure. It examines research studies that investigate the positive effects of exercise-based interventions, multidisciplinary team approaches, and nurse-led care on patient outcomes. Students are tasked with analyzing these studies to understand the impact of cardiac rehabilitation on survival rates, symptom management, quality of life, and readmission rates.

Running head: CARDIAC NURSING
Cardiac nursing
Name of the student:
Name of the University:
Author’s note

1CARDIAC NURSING
Cardiovascular disease is a great burden worldwide and it is now recognized as the
leading cause of death in the world. According to a review on cardiac disease burden worldwide,
it has been found that 32% of global death in the world has been caused due to cardiovascular
disease. The number of lives lost due to heart disease is increasing more rapidly in low and
middle income countries and there is a need to control regional variations in the diagnosis of
heart problems and the mortality associated with it. In response to high health care cost and
disease burden of cardiovascular disease, policy related changes is needed to address contextual
factors associated with risk of the disease. The global commitment is to reduce the rate of
premature cardiovascular disease by 25% by 2025. In response to this commitment, role of
cardiac rehabilitation is now realized to restore health of affected people (Roth et al., 2015). The
essay discusses the importance of cardiac rehabilitation for people with cardiac health needs and
explains the role of nurse in cardiac rehabilitation of patients with cardiovascular disease.
Cardiac rehabilitation is now a part of contemporary heart disease care and treatment
because it can treat wide spectrum of cardiac disease. It is defines as the combination of
interventions implemented to provide the best physical, psychological and social conditions to
patients with chronic cardiovascular disease and reduce the progression of disease and optimal
functioning of patients in the community. Wide range of strategies are employed during the
cardiac rehabilitation process which includes exercise, behavioral changes, education of healthy
behavior, psychological supports and other strategies (Anderson et al., 2016). The main benefit
of cardiac rehabilitation is that it has a major impact on heart failure etiology. A study
investigating the benefits of cardiac rehabilitation based on heart failure etiology gave the
indication that cardiac rehabilitation approaches like physical exercise has positive impact on
muscle fibre. The two years outpatient follow-up study also mentioned about the efficacy of

2CARDIAC NURSING
cardiac rehabilitation on stabilizing various clinical and laboratory parameter in heart patients.
Patient education helped them to stabilize their heart rate and maintain their weight too. The
study proved the benefits of clinical rehabilitation in heart failure patients and suggested exercise
training in all heart failure patients despite difference in heart failure etiology (Koukoui et al.,
2015).
Though exercise-based cardiac rehabilitation has been recommended by many studies,
most heart failure patients do not receive it. This might be due to the variation in the cost of
cardiac rehabilitation service. However, cardiac rehabilitation with emphasis on exercise is
considered important for patient because it has been found to reduce the mortality rate by 20-
30% compared to those who do not receive exercise interventions (Lewinter et al., 2015).
Another study showed the direct benefits of exercise training on coagulation and clotting factors
and development of inflammatory markers. Consistent results for reduction in cardiovascular
mortality with exercise activity has been found in many studies and across people with many
types of cardiovascular heart disease (Anderson et al., 2016).
Another study evaluated the effectiveness of exercise-based rehabilitation in terms of
mortality, hospital admission rates and health related quality of life. The study finding showed
that exercise rehabilitation does not reduce the risk of all cause mortality, however it leads to
reduction in hospital admissions rates and improvement in health related quality of life. In
addition, positive results from exercise training is consistent in participants irrespective of their
age, gender and severity (Taylor et al., 2014). Hence, considering the impact of clinical outcome
of patients, it is very important to provide such interventions to heart failure patients. It is
regarded as a cost effective and comprehensive approach to reducing risk factors and improving
physiological, functional, psychological and nutritional status of patients.

3CARDIAC NURSING
Despite numerous benefits of outpatient cardiac rehabilitation (CR), very few referrals
are given to patient for participation in such activities. One research suggested addressing the
barrier to participation in CR by educating the patients and health care system about the benefits
of CR and identifying the reason for lack of referral. To identify lack of referral to CR, it is also
necessary to analyze level of health investments and health system barriers such as poor
infrastructure and poor perception about the value of CR. In addition, to increase the
participation of people in outpatient CR, it would necessary to raise understanding about the
process and designing the CR programs in such a way that majority of patients can accept such
form of care. Increased coverage and implementation of innovative strategies to cover more
number of patients in such programs is also crucial to the achievement of the global commitment
for reduction in cardiovascular mortality rate. Several digitals tools has the advantage in raising
awareness and improving coverage of such program. For example, telemedicine, internet based
programs and mobile applications are useful tools to raise awareness about importance for CR in
restoring optimal functioning in cardiac failure patients (Arena et al., 2012). This approach will
help to address alarmingly low rate of participation in CR programs.
The above discussion proves that there are many evidence based article to prove the
efficacy of CR on improving health of patients with cardiovascular disease. It is
multidisciplinary approach to care where a team of nurse specialist, occupational therapist,
dietitian, phsyiotherapist and other support staffs helps patients to change behavior and self-
manage the disease by means of diverse CR activities. The cardiac rehabilitation nurse mainly
assist and guides patients to adapt to healthy path and lower the risk of heart disease. They
facilitate patients to bring lifestyle changes. Such nurse also requires communication skills to
persuade patients to adapt new health behavior and experience the benefits of positive life styles

4CARDIAC NURSING
changes. Improving the nursing education regarding CR program is also critical to maximize
beneficial effects on patient’s quality of life, body weight, exercise capacity, lipid profile, blood
pressure, mortality rate and myocardial infarction (Edmunds, 2012).
The first important role of nurse during cardiac rehabilitation is to educate patients and
counsel them regarding strategies to combat cardiovascular disease and get actively involved in
medical treatment. The hospitalization period is considered the most important point of initiation
of cardiac rehabilitation and interventions given by nurse is most likely to increase the
participation rate in CR programmes. A research study proved the critical role of nurse in
improving participation in CR programme. A community based intervention of home visit and
telephone calls from nurses were implemented and the data regarding the participation rate in CR
was calculated. The outcome of the study showed significant improvements in cardiac
rehabilitation programmes. The increase was seen after 1 years and hospitalization rate in
treatment group also improved considerably (Doll et al., 2015). Hence, this study further
confirms that nurse play a role in educating patents and promoting active participation in cardiac
rehabilitation programmes.
Nurse also educate patients after open heart surgery and such activities of nurse reduces
physical and emotional difficulties in patients. This does not means that nurse educate patents in
preoperative stage, they also implement preoperative education and counseling on post operative
complication. The nursing activity regarding education patients before and after surgery also
reduced stress in patients. One study selected study and control group. and the study group
patients received structural eduactoon and counseling course by nurse prior to surgery. The main
outcome of this research was that nurse initiated counseling sessions reduces the rate of

5CARDIAC NURSING
preoperative complications in patients and they also showed reduced level of anxiety post the
operation (Zhang et al., 2012).
Home based care is also a part of the cardiac rehabilitation programs. Home based care is
considered necessary to address high rehospitalization rates and premature death in people with
chronic health disease. Past studies have shown that exercise based CR do not reduce all cause of
mortality, however nurse led home based intervention has been found to bring improvements in
all cause of health outcomes. This is because home based interventions are more responsive to
clinical and psychological health needs of cardiovascular patient. One research study evaluated
the benefits of nurse led home based intervention (HBI) on outcome of patients. The common
elements of this intervention was home visit of registered cardiac nurse specialist after 7 to 14
days of hospitalization, follow up with multidisciplinary team, focus on addressing residual risk
in case of unplanned hospitalization and recommendation of long-term management of risk in
patients. The statistical analysis of research data revealed prolonged event-free survival and
increase in number of days spent outside hospital in patients receiving HBI (Stewart et al., 2016).
However, difference were found in effect of HBI on all cause mortality because of age factors
and concurrent diagnosis. Hence, changes in screening and referral protocols are likely to
improve nurse role in HBI in real world setting.
Many heart failure patients also have end of life care needs and palliative care are likely
to improve health of such patients. Research has shown there is lack of communication between
health care staffs and heart failure (HF) patients regarding prognosis. Many do not wish to
engage in such conversation because they feel that patients might not entered the terminal phase.
However, heart failure nurses hold a key responsibility in coordinating care of HF patient and
discuss about palliative care service with HF patients. One study evaluated nurse’s perspective

6CARDIAC NURSING
regarding discussion on prognosis and end of life care with patients. The main purpose of the
survey was to find out patient’s concern regarding discussing about prognosis and end-of life
care and find out barriers and facilitators to discussing palliative care with patients. The outcome
of the study gave idea about attitude, confidence and comfort of nurse in interaction with
patients. Most nurses had the opinion that they are supposed to discuss prognosis. 97% of nurse
were confident in discussing prognosis, however some nurses were uncomfortable that such
discussion might increase the stress level of patient (Hjelmfors et al., 2014). Hence, the main
conclusion from the study was that nurse found clinician to responsible for discussing palliative
care with HF patients. Though open communication is necessary to make informed decisions,
however it has been found nurse believed the main role of HF clinic is to provide medical
treatment and not educate patients. Hence, more encouragement activity is needed to make nurse
understand their communication responsibility in delivery basis palliative care.
As mentioned previously, cardiac rehabilitation is delivered by multidisciplinary team in
which specialist heart failure nurse also plays an important role. One research evaluated the
perception and experience of multidisciplinary and specialist HF nurse in management of heart
failure patients. This research work was important because of little knowledge regarding
specialist nurse role in working with multidisciplinary team. Nurse involvement is necessary and
their role begins at the initial diagnosis of heart failure. The study participants gave the insight
that education can be best delivered during interaction between nurse and pateinst during home
visit. The chances of assimilation of information in patients is also high in such case because
patients are more relaxed in home environment. However, nurses also reported that difference
patients have different capability to receive information. For instance, some patients may have
language difficulty or some may have cognitive disability. In such situation, nurse need to

7CARDIAC NURSING
balance educational needs in patients and provide personalized information. HF nurse also
emphasized the need for liaison with practitioners and clinicians (Glogowska et al., 2015).
Hence, the study gives the implication that specialist HF nurse plays an important role in
bridging the gap between primary and secondary care and managing heart failure patient.
The essay summarized the importance of cardiac rehabilitation on improving symptoms
and quality of life of heart failure patients. Many types of cardiac rehabilitation programs such as
home based care, exercise based CR, educating patients and self-management training has been
found to improve clinical outcome of patients. The review of research literature particularly
highlights the role of nurse in CR and how they intervene to educate patients, support them
during CR and provide psychological support to patients. However, studies have also pointed out
to certain barrier experience by nurse in implementing CR and in such case, addressing and
mitigating this barrier is considered important for reducing the morbidity and mortality
associated with heart disease.

8CARDIAC NURSING
Reference
Anderson, L., Oldridge, N., Thompson, D. R., Zwisler, A. D., Rees, K., Martin, N., & Taylor, R.
S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane
systematic review and meta-analysis. Journal of the American College of
Cardiology, 67(1), 1-12.
Arena, R., Williams, M., Forman, D. E., Cahalin, L. P., Coke, L., Myers, J., ... & Lavie, C. J.
(2012). Increasing referral and participation rates to outpatient cardiac rehabilitation: the
valuable role of healthcare professionals in the inpatient and home health
settings. Circulation, 125(10), 1321-1329.
Doll, J. A., Hellkamp, A., Ho, P. M., Kontos, M. C., Whooley, M. A., Peterson, E. D., & Wang,
T. Y. (2015). Participation in cardiac rehabilitation programs among older patients after
acute myocardial infarction. JAMA internal medicine, 175(10), 1700-1702.
Edmunds, L. (2012). Improving wellbeing with cardiac rehabilitation. Nursing times, 108(40),
17-19.
Glogowska, M., Simmonds, R., McLachlan, S., Cramer, H., Sanders, T., Johnson, R., ... &
Purdy, S. (2015). Managing patients with heart failure: a qualitative study of
multidisciplinary teams with specialist heart failure nurses. The Annals of Family
Medicine, 13(5), 466-471.
Hjelmfors, L., Strömberg, A., Friedrichsen, M., Mårtensson, J., & Jaarsma, T. (2014).
Communicating prognosis and end-of-life care to heart failure patients: A survey of heart
failure nurses’ perspectives. European journal of cardiovascular nursing, 13(2), 152-161.

9CARDIAC NURSING
Koukoui, F., Desmoulin, F., Lairy, G., Bleinc, D., Boursiquot, L., Galinier, M., ... & Rouet, P.
(2015). Benefits of cardiac rehabilitation in heart failure patients according to etiology:
INCARD French study. Medicine, 94(7).
Lewinter, C., Doherty, P., Gale, C. P., Crouch, S., Stirk, L., Lewin, R. J., ... & Bland, J. M.
(2015). Exercise-based cardiac rehabilitation in patients with heart failure: a meta-
analysis of randomised controlled trials between 1999 and 2013. European journal of
preventive cardiology, 22(12), 1504-1512.
Roth, G. A., Huffman, M. D., Moran, A. E., Feigin, V., Mensah, G. A., Naghavi, M., & Murray,
C. J. (2015). Global and regional patterns in cardiovascular mortality from 1990 to
2013. Circulation, 132(17), 1667-1678.
Stewart, S., Wiley, J., Ball, J., Chan, Y. K., Ahamed, Y., Thompson, D. R., & Carrington, M. J.
(2016). Impact of nurse-led, multidisciplinary home-based intervention on event-free
survival across the spectrum of chronic heart disease: composite analysis of health
outcomes in 1226 patients from 3 randomized trials. Circulation, CIRCULATIONAHA-
116.
Taylor, R. S., Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H., ... & Singh, S.
(2014). Exercise‐based rehabilitation for heart failure. The Cochrane Library.
Zhang, C. Y., Jiang, Y., Yin, Q. Y., Chen, F. J., Ma, L. L., & Wang, L. X. (2012). Impact of
nurse-initiated preoperative education on postoperative anxiety symptoms and
complications after coronary artery bypass grafting. Journal of Cardiovascular
Nursing, 27(1), 84-88.

10CARDIAC NURSING