Cardiac Rehabilitation
Hospital Clínico Universitario Virgen de la Victoria
Cardiac Rehabilitation
The Cardiac Rehabilitation Unit of Hospital Clínico Universitario Virgen de la Victoria was established in 1999. Its activities began with low-risk patients at Carranque Health Centre and progressed to the treatment of moderate and high-risk patients in 2003.
The Unit is a multidisciplinary team (cardiologists, rehabilitation specialists, physiotherapists, nurses, psychologists, family doctors, nutritionists, endocrinologists, urologists) who work as a team to achieve their ultimate goal: the correction of cardiovascular risk factors, the adoption of heart-friendly exercise habits , and the ultimate goal of achieving a heart-healthy lifestyle for effective secondary prevention.
The WHO defines cardiac rehabilitation as “the coordinated sum of interventions required to favorably influence the disease, ensuring the best physical, psychological, and social conditions, so that patients, by their own means, can maintain or resume their activities in society optimally. Rehabilitation should not be considered an isolated therapy, but rather integrated into the overall treatment of heart disease, of which it forms only one facet” (1993).
There is sufficient scientific evidence to support the effectiveness of secondary prevention and cardiac rehabilitation programmes, as they reduce cardiac mortality (26-34%), non-fatal cardiac events (46%), and overall mortality (20%), while also improving exercise capacity, helping control high blood pressure and high cholesterol as well as levels of depression and anxiety.
The Cardiac Rehabilitation Unit is innovative in its coordination with Primary Care from Phase II. Once assessed by the Unit’s physicians (cardiologist and rehabilitation specialist), low risk patients are referred to the Carranque Health Centre, where they receive treatment in the physiotherapy room, under supervision of a family doctor and a physiotherapist from the health centre. Moderate and high-risk patients are treated at the hospital, where there is direct, close supervision, continuous electrocardiographic monitoring during physical exercise and participation of the entire multidisciplinary team.
OUR RESULTS
Since our Unit opened, it has assessed 960 patients, 460 of whom have participated in the cardiac rehabilitation programme. The characteristics of the approximately 460 Phase II patients are as follows:
- 92% male.
- 95% had been diagnosed with ischemic heart disease, 40% of whom underwent aortocoronary bypass surgery, and the remaining 5% had surgically treated valvular heart disease.
- In terms of risk, the patients were low (47%), medium (43%), and high (10%).
- The average age was 52.38 years (25-71).
- There was a slight predominance of professions involving physical exertion (55.2%).
The predominant cardiovascular risk factors were smoking (85%), hypercholesterolemia (68%), hypertension (40%), diabetes (21%), and sedentary lifestyle (70%).
After the Phase II cardiac rehabilitation programme, 90% improved their functional capacity, measured with an exercise stress test. At the end of the programme, the best controlled cardiovascular risk factors (CVRF) were:
- Hypertension
- Diabetes Mellitus
- Sedentary lifestyle
- Smoking
- Hypercholesterolemia and obesity are the most difficult CVRFs to control, although 65% of patients manage them.
Long-term:
- 73.3% of patients engage in physical exercise: walking (56.7%), cycling (3.3%), both (13.3%).
- Medium and high-risk patients have a greater habit of physical exercise.
- Almost half of the patients (43.5%) remain in active employment.
INDICATIONS FOR CARDIAC REHABILITATION
| Ischemic heart disease: |
| · Myocardial Infarction (MI) |
| · Stable exertional angina |
| · Post heart surgery |
| · Post-angioplasty |
| Heart transplant |
| Chronic heart failure |
| Operated valvular heart disease |
| Operated congenital anomalies |
| Pacemakers or defibrillators |
| Healthy individuals with cardiovascular risk factors |
| Healthy middle-aged individuals starting sports activity |
CONTRAINDICATIONS FOR CARDIAC REHABILITATION
| RELATIVE CONTRAINDICATIONS |
|---|
| Unstable angina |
| Malignant arrhythmias: |
| · Exercise-induced extrasystole |
| – 2nd- and 3rd-degree AV block |
| · Ventricular tachycardia |
| · Uncontrolled SVT |
| Pulmonary embolism |
| Thrombophlebitis |
| Myocarditis and pericarditis |
| Severe hypertension (>200/110mmHg) |
| Acute heart failure |
| Decompensated diabetes |
| Infections |
| Inflammatory processes or illness in an acute phase |
| Psychiatric illness |
| ABSOLUTE CONTRAINDICATIONS |
|---|
| Aortic dissection |
| Severe left ventricular outflow tract stenosis |
| Severe physical disability |
| Psychiatric illness |
PHASES OF THE CARDIAC REHABILITATION PROGRAMME
There are 3 phases in the cardiac rehabilitation programme:
Phase I: during hospital admission
The objective is to overcome fears, begin gentle, progressive mobilization, and raise awareness of cardiovascular risk factor control.
Phase II: outpatient phase
This is the main phase. The objective is to adopt a heart-healthy lifestyle by controlling cardiovascular risk factors and taking appropriate physical exercise. It consists of several aspects: physical training, health education, and psychotherapy (Diagram 3).
Cardiologists and rehabilitation experts assess the patient in physical training, which is adapted to each individual’s situation, considering any co-existing conditions. In a training session, a patient will warm up before performing aerobic physical exercise on a cycle ergometer or treadmill, at 75% or 85% of the maximum heart rate they achieved during the stress test. Patients with greater severity are monitored and supervised, with continuous control of the heart’s response to exercise, aiming to achieve high rates of safety and effectiveness.
Health education talks offer patients the opportunity to learn about various cardiovascular risk factors, such as high blood pressure, high cholesterol, diabetes, smoking, a sedentary lifestyle, or obesity, as well as the beneficial effects of exercise, recommended diet, erectile dysfunction, career guidance, etc. Psychotherapy sessions aim to help patients learn to relax and manage stress and anxiety, which are very common in this type of patient.
Treatment is conducted in groups, 3 days a week for 2 months.
Phase III: maintenance phase
This phase lasts a lifetime. It is essential for patients to maintain the new habits acquired to prevent the occurrence of another cardiac event. In this phase, the role of Primary Care is essential in encouraging patients to keep cardiovascular risk factors under control.
Málaga, at the forefront of clinical care for patients with cardiovascular pathologies
The Heart Centre’s mission
The mission of the Heart Centre at Hospital Clínico Universitario Virgen de la Victoria is to improve people’s quality of life, addressing our patients’ vascular health challenges in innovative, sustainable ways, within a personalized environment that is welcoming, high-quality and safe.
OFFICIAL RESOURCES
Links to the Andalusian Health Service
Contact the Heart Centre of Hospital Clínico Universitario Virgen de la Victoria
Campus de Teatinos, S/N, 29010 Málaga
Hospital Switchboard: 951 032 000
Heart Centre Phone Numbers
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Heart UGC Address (5th Floor - Central Section)
Corporate Phone: 932 732 – External Phone: 951 032 732
Heart Centre Secretary (5th Floor - Central Section)
Corporate Phone: 932 560 – External Phone: 951 032 560
Cardiology and Cardiac Surgery Office (5th Floor - Central Section)
Corporate Phone: 932 054 – External Phone: 951 032 054
Catheterization Office (Ground Floor - Tower A)
Corporate Phone: 932 041 – External Phone: 951 032 041
Arrhythmia Office (1st Floor - Tower A)
Corporate Phone: 932 674 – External Phone: 951 032 674