Surviving a serious cardiovascular event can be frightening, as a person comes face to face with her own mortality. Some people use the fear as motivation to power their rehabilitation efforts. For others, the anxiety can be immobilizing. Stepping on a treadmill may feel like walking a tightrope over the Grand Canyon.
That's where testing your limits in a monitored environment like Princeton Baptist Medical Center's Cardiovascular Rehabilitation Center can make a difference. It's like learning to ride a bike with training wheels, along with a teacher who can step in if you need help.
"From the moment a heart patient arrives at Princeton, our cardiovascular team works together to tailor the care for each individual in order to move them toward the best possible outcome," said interventional cardiologist and director of Princeton's Cardiovascular Rehabilitation program Vasudeva Goli, MD. "Physical therapy usually begins in the hospital. Depending on the patient's condition and the procedure involved, he or she is usually ready to begin outpatient rehabilitation in two to four weeks. We custom design a program based on the patient's history and where he is now. Following a step-by-step plan, our rehab team helps patients move toward their goals as they regain strength, pulmonary capacity and function."
Completing a 12-week cardiovascular rehabilitation program has been shown to make a significant difference in outcomes.
"We recommended rehab for all our patients who have had a heart attack, heart surgery, a stent or who are experiencing stable angina. If we could persuade more people who qualify for cardiovascular rehab to get it, we could save thousands of lives and hospitalizations every year," Goli said.
When patients are referred to the rehab center, the first visit begins with a thorough assessment of each patient's condition to determine the appropriate starting point.
Nurse Manager of the Rehab Unit Lisa Williams said, "After going over the patient's history, we listen to their heart and lungs, check their heart rhythm and rate, and their blood pressure. Next, we do a six-minute walk with them to get a baseline. No two people start at the same place. We start where they are and work to where they need to be.
"Every day, usually three days a week for 12 weeks, we begin class by checking to make sure their condition indicates that they should be able to safely participate in the planned activities. One advantage for patients who choose rehab is that these check-ins allow us to spot things the patient's doctor may want to know about now, instead of waiting for the next office visit. For example, if blood pressure readings remain consistently elevated, we might need to consult with the physician about whether medication needs to be increased or changed.
"We also work to help patients modify the risk factors that caused the problem. This includes nutrition, smoking cessation, cholesterol and diabetes management, as well as the psycho-social impacts of living with heart disease, which can lead to depression and anxiety.
"As patients do more and see what they are capable of, they gain the confidence to continue using what they have learned. It becomes a new way of life, so they can live healthier and enjoy this second chance they have been given."
The rehab center offers multiple types of exercise equipment, including recumbent bikes, treadmills and arm ergometers to strengthen the upper body when patients are ready. Safety equipment includes a crash cart. And program director Goli is just one flight of stairs away if questions come up, a patient isn't feeling well or if he and the patient's doctor need to compare notes.
"Statistics show there is a major difference in long-term outcomes between people who completed the program and those who didn't come back at the first visit, both in survival rates and in the number of hospital readmissions," Williams said.
Goli said, "We're pushing to make cardiovascular rehab an option for a more patients. While there is insurance coverage for many, the copays may be more than some patients can manage. Others may have difficulty finding transportation or getting off work three times a week for classes. They may live too far from a rehab center or may not understand how important rehab is to living a fuller life."
To work around some of the difficulties in access, cardiologists could recommend online and video resources people can use on their own schedule. Eventually, the technology that made two-way virtual classrooms possible during the pandemic could be a possibility, matching up patients and teachers anywhere.
It's not the same as having a monitored class with health professionals and equipment in the same room when you are first testing your limits, but it's a step in the right direction.
