Comprehensive cardiac rehabilitation as the keystone in the secondary prevention of cardiovascular disease.

Comprehensive cardiac rehabilitation (CR) is a mainstay of the secondary prevention of cardiovascular disease. In the European Society of Cardiology guidelines, comprehensive cardiovascular rehabilitation has the highest class of recommendation and level of evidence as an effective method for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndrome, for CVD prevention in clinical practice, and in patients with heart failure (HF). This document presents an expert opinion of the Cardiac Rehabilitation and Exercise Physiology Section of the Polish Cardiac Society concerning the definition, goals, target population, organization of rehabilitation services, standard clinical indications and methods of implementation. Moreover, it describes psychosocial risk factors influencing the course of CR and secondary prevention of cardiovascular disease in patients undergoing CR. Comprehensive CR is as a process that should be implemented as soon as possible, continued without interruption, and consist of multiple stages. Moreover, it should be tailored to the individual clinical situation and should be accepted by the patient and their family, friends, and caregivers.

Electrocardiographic exercise testing in adults: performance and interpretation. An expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology.

Electrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk strati- fication in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.

[Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System]. / Opieka koordynowana po zawale serca. Stanowisko Polskiego Towarzystwa Kardiologicznego oraz Agencji Oceny Technologii Medycznych i Taryfikacji.

The in-hospital mortality following myocardial infarction has decreased substantially over the last two decades in Poland. However, according to the available evidence approximately every 10th patient discharged after myocardial infarction (MI) dies during next 12 months. We identified the most important barriers (e.g. insufficient risk factors control, insufficient and delayed cardiac rehabilitation, suboptimal pharmacotherapy, delayed complete myocardial revascularisation) and proposed a new nation-wide system of coordinated care after MI. The system should consist of four modules: complete revascularisation, education and rehabilitation programme, electrotherapy (including ICDs and BiVs when appropriate) and periodical cardiac consultations. At first stage the coordinated care programme should last 12 months. The proposal contains also the quality of care assessment based on clinical measures (e.g. risk factors control, rate of complete myocardial revascularisation, etc.) as well as on the rate of cardiovascular events. The wide implementation of the proposed system is expected to decrease one year mortality after MI and allow for better financial resources allocation in Poland.

Health-related quality of life in patients with coronary heart disease after residential vs ambulatory cardiac rehabilitation.

BACKGROUND: The aim of this study was to evaluate the influence of residential (RCR) vs ambulatory (ACR) cardiac rehabilitation (CR) on health-related quality of life (QOL) connected with changes in exercise capacity of patients with coronary heart disease (CHD). METHODS AND RESULTS: The 562 patients with CHD were studied: 313 participants in RCR and 249 participants in ACR. The examination was performed at the beginning of CR and after 8 weeks. QOL was assessed using the EuroQuol 5D (EQ-5D) and SF36 questionnaires. Exercise testing was performed with evaluation of workload during the last stage of the test and rate of perceived exertion intensity. In the first examination, patients from both groups did not differ significantly. After 8 weeks, a similar improvement in QOL was observed in both settings of CR according to EQ-5D and SF36 results. Health status was improved by 11.1% in the RCR group and by 10.4% in the ACR group. Last workload's intensity increased significantly by 32.1% in the RCR group and by 38.1% in the ACR group. The rate of perceived exertion intensity did not change despite the bigger workloads during the exercise test. CONCLUSIONS: Comprehensive CR improves health-related QOL and exercise capacity without differences between residential and ambulatory models.

[Results of the residential cardiac rehabilitation in patients after myocardial infarction treated with percutaneous coronary intervention (PCI)]. / Wyniki stacjonarnej rehabilitacji kardiologicznej u pacjentów po przebytym zawale miesnia sercowego leczonym angioplastyka pierwotna.

Patients after cardiac infarct and primary PCI are mainly people shortly immobilized with slight damage of the heart muscle with good condition and low consciousness of the disease. Development of the cardiology gives new goals for a cardiac rehabilitation. Traditional rehabilitation targets just like preventation results of immobilization and raising of efficiency are now not so important. Main task of modern rehabilitation, except function improvement of life quality, is preventation of progress coronary disease and reduction of mortality by changing health behavior, especially consent to regular physical activity. The purpose of this study was to evaluate physical efficiency and life quality of life in patients after myocardial infarction treated with PCI who participated in residential cardiac rehabilitations according to age and time of beginning this process. 167 patients (male) after myocardial infarction treated with primary PCI in age 33-82 years, mean age 57,1 +/- 8,92 (years). All patients participated in a 20 +/- 2 (days) comprehensive residential cardiac rehabilitation. ECG treadmill exercise test according Bruce protocol was performed after beginning and at the end of rehabilitation process. Quality of life was evaluated according to SF-36 questionnaire completed at the beginning and after rehabilitation programm. Residential cardiac rehabilitation increases physical efficiency and improves quality of life in patients who undergo primary PCI after myocardial infarction. Effects of cardiac rehabilitation dose not depend on age or on time of beginning of rehabilitation. Most significant increase of physical efficiency was observed in patients who were referend to cardiac rehabilitation no longer then 6 weeks after cardiac event.