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, beginning its activities with low-risk patients at the Carranque Health Center. Subsequently, in 2003, treatment for moderate and high-risk patients commenced.
The Unit is comprised of a multidisciplinary team (cardiologist, rehabilitation specialists, physiotherapists, nurses, psychologists, family doctors, nutritionist, endocrinologist, urologist) who work in an integrated manner to achieve their ultimate goal: correcting cardiovascular risk factors, adopting a heart-appropriate exercise habit, and ultimately, 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 supporting the effectiveness of secondary prevention and cardiac rehabilitation programs, as they decrease cardiac mortality (26-34%), non-fatal cardiac events (46%), and overall mortality (20%), while also improving exercise capacity, control of arterial hypertension, hypercholesterolemia, and levels of depression and anxiety.
The Cardiac Rehabilitation Unit is innovative in its coordination with Primary Care from Phase II. Low-risk patients, once assessed by the Unit’s physicians (cardiologist and rehabilitation specialist), are referred to the Carranque Health Center, where they receive treatment in the physiotherapy room, supervised by a family doctor and a physiotherapist from that center. Moderate and high-risk patients are treated at the hospital, where there is direct and close supervision, with continuous electrocardiographic monitoring during physical exercise and the participation of the entire multidisciplinary team.
OUR RESULTS
Since its inception, our Unit has assessed 960 patients, of whom 460 have participated in the cardiac rehabilitation program. Of the patients treated in Phase II (approximately 460), the patients had the following characteristics:
- 92% were male.
- 95% had been diagnosed with ischemic heart disease, of which 40% had undergone aortocoronary bypass surgery, and the remaining 5% had surgically treated valvular heart disease.
- According to risk, they were low (47%), medium (43%), and high (10%).
- The average age was 52.38 years (25-71).
- With 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 program, 90% improved their functional capacity, as measured by an exercise stress test. At the end of the program, the cardiovascular risk factors (CVRFs) best controlled by patients were:
- Hypertension
- Diabetes Mellitus
- Sedentary lifestyle
- Smoking
- Hypercholesterolemia and obesity are the CVRFs most difficult 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 an active employment situation.
INDICATIONS FOR CARDIAC REHABILITATION
| Ischemic heart disease: |
| · Myocardial Infarction (MI) |
| · Stable exertional angina |
| · Post-coronary surgery |
| · Post-angioplasty |
| Heart transplant |
| Chronic heart failure |
| Operated valvular heart disease |
| Operated congenital anomalies |
| Pacemakers or defibrillators |
| Healthy individuals with CVRF |
| 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 acute phase illness |
| Psychiatric illness |
| ABSOLUTE CONTRAINDICATIONS |
|---|
| Dissecting aortic aneurysm |
| Severe left ventricular outflow tract stenosis |
| Severe physical disability |
| Psychiatric illness |
PHASES OF THE CARDIAC REHABILITATION PROGRAM
The cardiac rehabilitation program consists of 3 phases:
Phase I: during hospital admission
The objective is to overcome fear, initiate early gentle and progressive mobilization, and raise awareness of cardiovascular risk factor control.
Phase II: or outpatient phase
This is the main phase. The objective is to adopt a heart-healthy lifestyle through the control of cardiovascular risk factors and appropriate physical exercise. It consists of several aspects: physical training, health education, and psychotherapy (Diagram 3).
For physical training, the patient is assessed by cardiology and rehabilitation. In this way, the training is adapted to each individual’s situation, considering any comorbidities. Thus, in a training session, after a warm-up phase, the patient will perform aerobic physical exercise, on a cycle ergometer or treadmill, at 75% or 85% of the maximum heart rate achieved in 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 hypertension, hypercholesterolemia, diabetes, smoking, 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/week for 2 months.
Phase III: or maintenance phase
This phase lasts a lifetime. The patient must maintain the new habits acquired to prevent the occurrence of another cardiac event. In this phase, the role of Primary Care is essential to encourage the patient to maintain control of cardiovascular risk factors.
Málaga, at the forefront of clinical care for patients with cardiovascular pathologies
Mission of the Heart Area
The mission of the Heart Area at Hospital Clínico Universitario Virgen de la Victoria is to improve the quality of life and address the vascular health challenges of individuals, in an innovative and sustainable way, within a friendly, quality, safe, and personalized environment.
OFFICIAL RESOURCES
Links to the Andalusian Health Service
Contact the Heart Area of Hospital Clínico Universitario Virgen de la Victoria
Campus de Teatinos, S/N, 29010 Málaga
Hospital Switchboard: 951 032 000
Heart Area Phone Numbers
Click on each block to display the corresponding phone number
Heart UGC Address (5th Floor - Central Section)
Corporate Phone: 932 732 – External Phone: 951 032 732
Cardiology Assistant (5th Floor - Central Section)
Corporate Phone: 932 560 – External Phone: 951 032 560
Cardiology and Cardiac Surgery Secretariat (5th Floor - Central Section)
Corporate Phone: 932 054 – External Phone: 951 032 054
Hemodynamics Secretariat (Ground Floor - Tower A)
Corporate Phone: 932 041 – External Phone: 951 032 041
Arrhythmia Secretariat (1st Floor - Tower A)
Corporate Phone: 932 674 – External Phone: 951 032 674
