Authors

• Mario Ivanuša — Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia — ORCID: 0000-0002-6426-6831

Keywords

cardiac rehabilitation, prevention, therapeutic education

DOI

Full Text

Nowadays, a rehabilitation centre stands as a better place for cardiovascular health as it combines diagnostics, treatment, education and evaluation of patients delivered by an interdisciplinary team. Cardiovascular rehabilitation (CVR) program is traditionally carried out in a hospital or outpatient environment. Following the COVID pandemic, more focus has been on virtual CVR which can be either synchronous (direct interaction of staff and patient across different locations) or asynchronous (using technology to remotely transfer data and educational content). Considering the availability, life tempo and desire to return to work activities as soon as possible, hybrid CVR is becoming more dominant as it combines onsite and virtual approach of the program. (1) Cardiovascular rehabilitation is an evidence-based and medically supervised intervention and part of secondary prevention of cardiovascular (CV) disease. It is executed according to the guidelines of professional societies and has different goals depending on the stage of the disease. (2) During the initial hospital treatment (Phase I CVR), the goal is informing and motivating needed for the necessary change of CV risk factors, alongside support and guidelines for discharge / early mobilization. Phase II CVR goals depend on the achieved level of patient motivation for rehabilitation after CV event or procedure. They can be recovery of functional capacity, cardiovascular optimization, psychological wellbeing, therapeutic education (**Table 1**), improving the quality of life as well as documentation and monitoring of adherence. In the maintaining phase (Phase III CVR) activities learned in previous stages are continuously executed with a goal of lowering the risk of CV morbidity and mortality. ### TABLE 1: Therapeutic education workshops for outpatient cardiovascular rehabilitation patients ( Phase II ) during the pandemic period at the Institute for Cardiovascular Disease Prevention and Rehabilitation Zagreb. | Education is continuously provided over a period of 3 months. All cardiovascular rehabilitation team members provide education individually or in small groups. | Education is continuously provided over a period of 3 months. All cardiovascular rehabilitation team members provide education individually or in small groups. | Education is continuously provided over a period of 3 months. All cardiovascular rehabilitation team members provide education individually or in small groups. | Education is continuously provided over a period of 3 months. All cardiovascular rehabilitation team members provide education individually or in small groups. | Education is continuously provided over a period of 3 months. All cardiovascular rehabilitation team members provide education individually or in small groups. | Education is continuously provided over a period of 3 months. All cardiovascular rehabilitation team members provide education individually or in small groups. | | --- | --- | --- | --- | --- | --- | | **Nurse workshops** | **Psychologist workshops** | **Physiotherapist workshops** | **Nutritionist workshops** | **Music therapist workshops** | **Kinesiologist** **workshops** | | Passport for life | What to do with anger? | Let’s breathe for the hearth | Heart and sugar | | | | Risk factors: • arterial hypertension | Communication - Me | Neck and shoulder exercises | Heart and salt | | | | Risk factors: • smoking | Communication - You | Heart relaxation | How and why to lower the body mass | | | | Risk factors: • stress | How to stand up for yourself - assertiveness | | | | | | Risk factors: • adequate nutrition and health meal preparation | Our daily stress | | | | | [†] Risk factors: • without sugar please [†] Educational materials are available both offline and on the website of the Institute. [†] Depending on the risk stratification and the patient’s progress, we also carry out additional interventions aimed at metabolic, psychosocial and other risk factors or changes in exercise capacity Despite the negative impact on health and life quality, CV event should motivate patients to take care of their health, acquire new knowledge and change their unhealthy behavior, while accepting CV therapy to ensure increased functionality and lower the risk of future complications. (3)

Literature

1. Lee JY. The History and Overview of Cardiac Rehabilitation and Secondary Prevention. J Cardiovasc Interv. 2024 July;3(3):98–118. https://doi.org/10.54912/jci.2024.0003
2. Brown TM, Pack QR, Aberegg E, Brewer LC, Ford YR, Forman DE, et al. American Heart Association Exercise, Cardiac Rehabilitation and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2024 September 24;. https://doi.org/10.1161/CIR.0000000000001289
3. Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur Heart J. 2023 February 7;44(6):452–69. https://doi.org/10.1093/eurheartj/ehac747