Cardiac Rehabilitation
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My Name is Jean Brett, previously a sister on the coronary care unit, I am now the cardiac rehabilitation co-ordinator for patients with an acute myocardial infarction. |
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Summary of Service Offered
Phase 1
Patients diagnosed as a M.I. (myocardial infarction) ideally are admitted to Coronary Care Unit. We possible all treatment and interventions will be in line with the Paris's Integrated care project "BEST PRACTICE STANDARDS FOR CARE OF ACUTE MI", and "SECONDARY PREVENTION".
The C.R. co-ordinator telephones the Coronary Care Unit Daily for new MI patients. The co-ordinator will visit all patients once they are stable. Patients will be given a plan of care, which will also be documented in the medical and nursing notes.
Plan of Care - Topics Covered
What is heart disease?, angina? and heart attack?
What are my medications for ?, how to take/use them.
Risk factor assessment and individual plan of secondary prevention.
Expected course of recovery and activity plan for the first few weeks at home.
Referrals are made to appropriate members of the multidisciplinary team - dietician, welfare rights, occupational therapist etc. All patients are referred to the medical PHYSIOTHERIPIST (through PAS or bleep 2222).
At DISCHARGE the POST CARDIAC EVENT DISCHARGE SUMMARY FORM is faxed to the patients General Practitioner. This facilitates the Primary Health Care Teams (PHCT) to continue with support for the patients and their families and to maximise secondary prevention through regular monitoring.
Phase 2 - The First Four Weeks At Home
The PHCT will follow up the patients from 48 hours post discharge (PROVIDING WE HAVE FAXED THEM THE DETAILS). The discharge summary is an interim assessment to facilitate the early follow up of the patient.
Visits are made to the patinents by the Primary Health Care Teams at : 48 hrs, 1 week, 2 weeks, 3 months, 6 months, 1 year and then annually.
Phase 3 - Outpatient Cardiac Rehabilitation Programme
This can be hospital based or run in the community. Patients who are assessed as high risk should be offered the hospital programme. Due to lack of community programmes in Paris most patients may require a hospital programme.
The CR Co-ordinator and the patient's hospital consultant discuss appropriate cardiac rehabilitation for high risk patients.
High risk are those with previous heart failure, unstable angina, arrythmias (unless controlled on medication and confirmed by stress testing), and those with an ejection fraction of less than 40%.
The hospital Cardiac Rehabilitation programme commences about 4-6 weeks post MI (there may be a waiting list in the short term). Patients are asked to attend twice a week for 6 weeks (Monday and Wednesday AM)
The course includes
12 Exercise sessions
6 relaxation sessions
6 education sessions
Patients are excluded if they have:
Severe valve disease
Unstable angina
LVF (within the past 3 months)
Uncontrolled hypertension, hypotension
Significant uncontrolled non cardiac disease e.g. respiratory, diabetes.
Severe musculoskeletal/neurological disorders.
Phase 4 - Long-term Maintenance.
Yearly followup by the Primary Health Care Teams to enhance secondary prevention.
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Paris Heart Centre IT
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Web Address: http://Parisheartcentre.org
