A Closer Look at Post-Acute Cardiac Care
By MELANIE KILGORE-HILL
More Patients Finding Meaning, Motivation in Recovery
More than 790,000 Americans experience heart attacks each year. For those fortunate enough to overcome, the days and months following a cardiac event are crucial to long-term survival.
"The reality is exercise is medicine, whether its prior to a cardiac event to increase survival or in a post-event period to help your heart recover and revascularize from what it's been through," said David Liddle, MD, FACP, director of the Vanderbilt Dayani Center for Health and Wellness.
The center specializes in patients recovering from or managing medical conditions and helps patients facing medical challenges such as heart and lung disease, movement disorders, chronic pain, cancer and obesity. In 2017 Dayani staff helped more than 200 cardiac rehab patients find the path to better health.
"The data that supports the importance of exercise after a cardiac event is pretty overwhelming," Liddle said. "No one can argue against that fact, although it's more challenging to start a routine after someone's had an event."
For many patients, a life-changing event serves as an unwelcomed reminder of one's own mortality and helps spur on tough changes. At the Dayani Center, a team of specialists including doctors, physical therapists, exercise physiologists, nurses, respiratory therapists and a health psychologist help motivate patients to work toward better health. Services include supervised exercise, aquatic programs, nutrition and other physical rehabilitation programs.
One of the valuable tools used by Dayani team members is motivational interviewing. "We find out how a patient's event has changed them, and what they would like to change," Liddle said. "What do they want to be around for? We can tell someone they'd be happier and healthier with these changes, but what would those changes actually mean to them?" Family, retirement or career goals all are strong motivators for patients, and those factors are put on a visual analogue scale to encourage progress.
As the only certified medical fitness center in Middle Tennessee, Dayani staff members also care for people with left ventricular assist devices (LVAD) to improve morbidity rates. Their comprehensive approach also includes blood work and a six-minute walk test, but Liddle emphasized that better numbers don't necessarily translate into feeling better. That's why staff also screen for depression and take holistic approaches to establish objective measures for patients.
"If they don't know what's in it for them, they're not likely to do it for the data," Liddle said. "Are patients feeling like they're meeting their own goals or ours? That patient-centered, motivation-driven experience is what sets us apart."
Dr. Steven Humphrey
Cardiologist Steven Humphrey, MD, chief of medicine at TriStar Southern Hills Medical Center, said pushing the heart is the most important benefit of cardiac rehab.
"So many patients have to get through a tremendous emotional barrier to get back to their full activities," Humphrey said. "Physically the heart may be a lot stronger ... but in a lot of cases, there's a great deal of post-op discomfort. Patients have to learn the difference between typical post-op discomfort and dangerous cardiac problems."
Centennial Heart at TriStar Southern Hills educates post-acute heart patients through their three-phase cardiac rehab program. The program consists of monitored exercise, diet instructions, disease management, education and counseling services to help patients increase physical fitness, reduce cardiac symptoms and reduce risk of future heart problems.
"The indication for cardiac rehab is expanding quite significantly," said Humphrey. "Historically after a bypass or valve surgery, we begin patients in a 12-week program, three days a week for an hour. We have data that shows patients who've had surgery or are in heart failure and go through cardiac rehab live longer."
Southern Hills' cardiac rehab program offers on-demand EKGs as patients start to push themselves and break through physical and emotional barriers post-surgery. While the hospital doesn't offer heart surgery, Humphrey said 90 percent of heart patients never even require surgery or a stent. That means patients often receive everything they need for improved cardiac health in their own community.
In 2018, electrophysiology will be added to the hospital's growing list of cardiac services, which currently include endovascular grafting and stenting, minimally invasive direct coronary artery, pacemakers, percutaneous coronary intervention, peripheral vascular angioplasty and intra-aortic balloon pumps. "Southern Hills was the region's first hospital to offer community-based stent placement, and those services are being expanded, as well," Humphrey said.