CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
Cardiac rehabilitation
Rehabilitation at cardiac rehabilitation centers
1. Introduction
1.1. Goals of CR
“The sum of interventions required to ensure the best possible physical, psychological and social
conditions, so that the patient with subacute or chronic heart disease may, by their own efforts,
preserve or resume a place as normal as possible in the life of the community” (ESC, WHO)
↓ restrictions (physical, psychological, social)
↓ symptoms
Slowing down the atherosclerotic process (education, modification risk factors, exercise
therapy)
Secondary prevention (short term): cost-effective
– ↓ CV mortality, morbidity, disability
– ↑ QOL
Tertiary prevention (long term)
– Preventie van nieuwe insults
1.2. CR in Belgium
Regulation by K.B. (Koninklijk Besluit) 10/1/1991 = governmental decision
Phase 1: hospitalized
– Pluridisciplinary CR sessions in hospital are provided individually to the patients (with
a reimbursement up to 30 sessions).
o Mobilisatie, psychologisch…
Phase 2: outpatient setting (until work resumption?)
– in specialized centers (CR center)
– in private practices
Phase 3: secondary and tertiary prevention (lifestyle)
– Patient neemt zelf meer initiatief
Facts:
15-30% of patients has access to phase 2 in a specialized centre
10-15% of patients undergo phase 2 rehab in a specialized centre
Reasons for small number in CR centres:
Patient refuses rehab (distance to a centre, lack of time, self-confidence, or practical issues
f.i. lack of transportation possibilities)
Lack of follow up and recommendation by a cardiologist
Administrative problems: only phase 2 when application for rehab was filled in the first 15
days of hospitalisation
Geographical distribution of CR centres
Main positive points cited by patients who completed CR
Improved physical and mental condition
Quality of support
Group motivation
Characteristics of non-participants
,CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
Elderly people
Women
Self-employed
Socio-economically deprived
Take your time for education and motivation for phase 2 (during phase 1)
Characteristics of participants
Highly educated
Bigger salary and not self-employed
Presence of CR center in the neighborhood
Percentage of surgery patients who receive at least one post-discharge multidisciplinary session
Regios waar er geen
rehabilitatiecentrum is zullen minder
gaan vooral in het zuiden
Percentage of patients with heart surgery that do not get a single rehabilitation session after
discharge from the hospital
Ook vooral in het zuiden
Er is een link tussen de afstand en het
al dan niet deelnemen aan
rehabilitatie
Maw het al dan niet aanwezig zijn van
CR, in Wallonië zijn er namelijk niet zo
veel waardoor de cijfers hier lager
liggen
Criteria for official cardiac rehabilitation centers: specific conditions
,CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
Minimal human resources: specialist physician specialized in CR + 2 of following:
– physiotherapist, psychologist, social worker; dietician or occupational therapist;
Adapted rooms for training and for conversation;
Material for monitoring + resuscitation
Multidisciplinary outpatient sessions have a minimal duration of 60 minutes and are group sessions
(with a reimbursement up to 45-90 sessions).
Nomenclature code PHASE 2 OUTPATIENT: 771212
Min. duration = 60 min
Multidisciplinary treatment
Reimbursement
– General: within the 6 months after first day of hospitalisation – for 45x
– After transplantation: within the 10 months after the first day of hospitalisation – for
90x
Only after application within first 15d of hospitalisation
Patient eligibility criteria for pluridisciplinary CR
=
geschiktheidscriteria
= when hospitalized for:
AMI (with troponin elevation (blood));
Coronary surgery; (vb CABG)
Percutaneous intervention;
Surgery for heart abnormality;
Heart (lung) transplant;
Cardiomyopathy with left ventricular dysfunction.
+ application for rehabilitation (within the first 15d of the hospitalization)
, CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
2. Principles of exercise training
2.1 Training modalities
Exercise training should be prescriped according to the FITT model
As a general advice recommend:
2.1.1 strength training
“Quadriceps strength as predictor of mortality in coronary artery disease”
Clinical significance
A high level of Qceps strength was strongly associated with lower risks of all-cause and CV
mortality in patients with coronary artery disease
Patient verliest veel vetvrije massa spierzwakte
Cardiac rehabilitation
Rehabilitation at cardiac rehabilitation centers
1. Introduction
1.1. Goals of CR
“The sum of interventions required to ensure the best possible physical, psychological and social
conditions, so that the patient with subacute or chronic heart disease may, by their own efforts,
preserve or resume a place as normal as possible in the life of the community” (ESC, WHO)
↓ restrictions (physical, psychological, social)
↓ symptoms
Slowing down the atherosclerotic process (education, modification risk factors, exercise
therapy)
Secondary prevention (short term): cost-effective
– ↓ CV mortality, morbidity, disability
– ↑ QOL
Tertiary prevention (long term)
– Preventie van nieuwe insults
1.2. CR in Belgium
Regulation by K.B. (Koninklijk Besluit) 10/1/1991 = governmental decision
Phase 1: hospitalized
– Pluridisciplinary CR sessions in hospital are provided individually to the patients (with
a reimbursement up to 30 sessions).
o Mobilisatie, psychologisch…
Phase 2: outpatient setting (until work resumption?)
– in specialized centers (CR center)
– in private practices
Phase 3: secondary and tertiary prevention (lifestyle)
– Patient neemt zelf meer initiatief
Facts:
15-30% of patients has access to phase 2 in a specialized centre
10-15% of patients undergo phase 2 rehab in a specialized centre
Reasons for small number in CR centres:
Patient refuses rehab (distance to a centre, lack of time, self-confidence, or practical issues
f.i. lack of transportation possibilities)
Lack of follow up and recommendation by a cardiologist
Administrative problems: only phase 2 when application for rehab was filled in the first 15
days of hospitalisation
Geographical distribution of CR centres
Main positive points cited by patients who completed CR
Improved physical and mental condition
Quality of support
Group motivation
Characteristics of non-participants
,CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
Elderly people
Women
Self-employed
Socio-economically deprived
Take your time for education and motivation for phase 2 (during phase 1)
Characteristics of participants
Highly educated
Bigger salary and not self-employed
Presence of CR center in the neighborhood
Percentage of surgery patients who receive at least one post-discharge multidisciplinary session
Regios waar er geen
rehabilitatiecentrum is zullen minder
gaan vooral in het zuiden
Percentage of patients with heart surgery that do not get a single rehabilitation session after
discharge from the hospital
Ook vooral in het zuiden
Er is een link tussen de afstand en het
al dan niet deelnemen aan
rehabilitatie
Maw het al dan niet aanwezig zijn van
CR, in Wallonië zijn er namelijk niet zo
veel waardoor de cijfers hier lager
liggen
Criteria for official cardiac rehabilitation centers: specific conditions
,CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
Minimal human resources: specialist physician specialized in CR + 2 of following:
– physiotherapist, psychologist, social worker; dietician or occupational therapist;
Adapted rooms for training and for conversation;
Material for monitoring + resuscitation
Multidisciplinary outpatient sessions have a minimal duration of 60 minutes and are group sessions
(with a reimbursement up to 45-90 sessions).
Nomenclature code PHASE 2 OUTPATIENT: 771212
Min. duration = 60 min
Multidisciplinary treatment
Reimbursement
– General: within the 6 months after first day of hospitalisation – for 45x
– After transplantation: within the 10 months after the first day of hospitalisation – for
90x
Only after application within first 15d of hospitalisation
Patient eligibility criteria for pluridisciplinary CR
=
geschiktheidscriteria
= when hospitalized for:
AMI (with troponin elevation (blood));
Coronary surgery; (vb CABG)
Percutaneous intervention;
Surgery for heart abnormality;
Heart (lung) transplant;
Cardiomyopathy with left ventricular dysfunction.
+ application for rehabilitation (within the first 15d of the hospitalization)
, CRK2 – Cardiac rehabilitaition (Lauren de Cock, Wendy Hens) Loranne den Otter
2. Principles of exercise training
2.1 Training modalities
Exercise training should be prescriped according to the FITT model
As a general advice recommend:
2.1.1 strength training
“Quadriceps strength as predictor of mortality in coronary artery disease”
Clinical significance
A high level of Qceps strength was strongly associated with lower risks of all-cause and CV
mortality in patients with coronary artery disease
Patient verliest veel vetvrije massa spierzwakte
