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Medical Forum / General / Cardiology / September 2007cardiac rehab
Cardiac Rehab Underutilized Cardiac rehabilitation is "vastly underutilized" and given to less than a third of eligible patients with cardiovascular disease, according to a position paper published online in Circulation. The article cites low referrals as a contributing factor. Patients who've had at least one of the following conditions over the past year - myocardial infarction/acute coronary syndrome, bypass surgery, percutaneous coronary intervention, stable angina, heart valve surgical repair or replacement, and heart or heart/lung transplantation - should be referred for cardiac rehabilitation, says the report. Cardiac rehabilitation begins when the patient is still in the hospital, then continues with early outpatient care (typically 3 to 6 months after a CVD event) followed by long-term preventive and rehabilitation services. The best documented effect on mortality occurs in the early outpatient phase. An earlier meta-analysis concluded that the exercise portion of cardiac rehabilitation can reduce mortality by 27%. http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.185734v1 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001800/frame.html >Cardiac Rehab Underutilized I can believe it. After my CABGx5, I requested rehab but was told I was in better shape leaving the hospital than most people are after completing rehab. Granted, I was pretty fit, but I had the feeling there was some other reason although I haven't a clue what it might have been. Anyhow, I ended up in the ER 5 months after the CABG, then up to the Cath Lab for an Angioplasty and a couple of stents, even though I was doing physical rehab on my own. I've often wondered if that would have happened if I'd been rehabbed by somebody that knew what they were doing. Port > >Cardiac Rehab Underutilized > [quoted text clipped - 10 lines] > > Port Port you have been through a lot ! Going back so soon to the Cath lab without sufficient time to forget what it entails is tough. I had CABG 4X 6 years ago. No one mentioned rehab and I was out in three days. Saw my surgeon two weeks latter and he just said there was no need to see him further after he scraped my knee vein problem I had with healing. He did mention the other Cardio folks would be plying me with drugs. My PCP was out of the loop till I called and asked to see them due to hemorrhoids that occurred about three weeks latter. Bill  SignatureS Jersey USA Zone 5 Shade This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. http://www.ocutech.com/ High tech Vison aid >Port you have been through a lot ! I guess... but such is life. I've learned a lot too. I wish I'd known 20 years ago what I know now..... And I wish I knew now what I hope to know in another 20 years lol! Port friend P...@nospam.invalid wrote: > >Cardiac Rehab Underutilized > [quoted text clipped - 10 lines] > > Port Your underlying problem going into the CABG clearly was not lack of exercise so that it is not surprising that your physical rehab did not prevent progression of your CAD. Similarly, Marilyn's husband does not have CAD because of lack of exercise. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist >Your underlying problem going into the CABG clearly was not lack of >exercise Ain't *that* the truth. In fact my fitness level was a major factor in my docs' misdiagnosis (for three years) after my symptoms first appeared. >so that it is not surprising that your physical rehab did not >prevent progression of your CAD. We live and we learn. Just takes some of us a little longer than others ;-) Port <----duh P...@nospam.invalid wrote: > Andrew, in the Holy Spirit, boldly wrote: > > >Your underlying problem going into the CABG clearly was not lack of > >exercise > > Ain't *that* the truth. As oft written, it remains my choice to continue writing truthfully :-) > In fact my fitness level was a major factor in my docs' misdiagnosis > (for three years) after my symptoms first appeared. Many people have been misled to falsely believe that physical exercise resulting in a high fitness level is a guarantee that there will be no cardiovascular disease. Many doctors are sadly among the many who have been misled. > >so that it is not surprising that your physical rehab did not > >prevent progression of your CAD. > > We live and we learn. Just takes some of us a little longer than > others ;-) Less time when also learning through the experiences of others :-) My wish for you would be that you become healthier (hungrier) than ever by your losing the VAT so that your WHR becomes lower than 0.85. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com Bondservant to the KING of kings and LORD of lords. > P...@nospam.invalid wrote: > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 14 lines] > cardiovascular disease. Many doctors are sadly among the many who > have been misled. Actually, I have never heard a single health care professional say that a high level of fitness is a "guarantee" that there will be no cardiovascular disease. Have you? I have heard many a health care professional state that a high level of fitness reduces the likelihood of cardiovascular disease. Do you dispute that? -- cary > Andrew, in the Holy Spirit, boldly wrote: > > friend P...@nospam.invalid wrote: [quoted text clipped - 19 lines] > say that a high level of fitness is a "guarantee" that there will > be no cardiovascular disease. Have you? It is not uncommon for folks to say one thing and yet believe something else in their hearts. It is our hearts that can make us hypocrites if satan has his lies growing in there. > I have heard many a health care professional state that > a high level of fitness reduces the likelihood > of cardiovascular disease. Do you dispute that? If a person has been overeating, there will be cardiovascular disease that will not be reversed with exercise. Be hungry... be healthy... be hungrier... be blessed: http://HeartMDPhD.com/PressRelease Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com Bondservant to the KING of kings and LORD of lords. > > Andrew, in the Holy Spirit, boldly wrote: > > > friend P...@nospam.invalid wrote: [quoted text clipped - 18 lines] > It is not uncommon for folks to say one thing and yet believe > something else in their hearts. > It is our hearts that can make us hypocrites if satan has his lies > growing in there. And your inferring, without a shred of evidence, other peoples' beliefs to suit your own convenience is an act of .... whom? > > I have heard many a health care professional state that > > a high level of fitness reduces the likelihood > > of cardiovascular disease. Do you dispute that? > > If a person has been overeating, there will be cardiovascular disease > that will not be reversed with exercise. Are you saying that routinely eating more than two pounds a day will inevitably lead to heart disease? -- cary > Andrew, in the Holy Spirit, boldly wrote: > > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 25 lines] > And your inferring, without a shred of evidence, other peoples' beliefs > to suit your own convenience is an act of .... whom? Your bearing false witness would be your own act. Your act is forgiven by me. > > > I have heard many a health care professional state that > > > a high level of fitness reduces the likelihood [quoted text clipped - 5 lines] > Are you saying that routinely eating more than two pounds a day > will inevitably lead to heart disease? No. A person could die of other causes before acquiring cardiovasular disease from overeating. Be hungry... be healthy... be hungrier... be blessed: http://HeartMDPhD.com/PressRelease Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com Bondservant to the KING of kings and LORD of lords. > Are you saying that routinely eating more than two pounds a day > will inevitably lead to heart disease? "No. A person could die of other causes before acquiring cardiovasular disease from overeating." Note the answer fits another question not asked. This cheap trick is often used by polititians wanting to avoid the truth. The calery content of food varies greatly for the same amount of weight. Calorie intake and weight status is a long established conclusion in medicine. The truthful answer is that it depends on the calorie count in the two pounds. Eating excess calories causing overweight can lead to heart problems but only as expressed in some level of increased risk and not in absolute terms. When does ommission by cheap politition trick become a sin? God bless. > > Andrew, in the Holy Spirit, boldly wrote: > > > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 42 lines] > No. A person could die of other causes before acquiring cardiovasular > disease from overeating. And cyanide doesn't always kill because you might be hit by a car before it can set in. Now that we've both been comparably silly, let's see if you have the "boldness" to stop dissembling and give a straight answer: in the absence of other causes of of death, is it you claim that routinely eating more than two pounds of food a day will inevitably lead to cardiovascular disease? You can live up to your self-proclaimed "boldness" now, or you can duck and weave some more. Which will it be? -- cary > And cyanide doesn't always kill because you might be hit > by a car before it can set in. Mustn't give Dr. Chung "ideas." > Andrew, in the Holy Spirit, boldly wrote: > > > Andrew, in the Holy Spirit, boldly wrote: [quoted text clipped - 52 lines] > you claim that routinely eating more than two pounds of > food a day will inevitably lead to cardiovascular disease? Yes. However, the discerning would perceive that logically there is no answer to your question except "yes" so that answering your question is meaningless, that there has been no dissembling, and that it remains my choice to continue writing truthfully. Per GOD's will, truthful answers do not appear straight to the untruthful. > You can live up to your self-proclaimed "boldness" now, or > you can duck and weave some more. Which will it be? It remains my choice to continue receiving the guidance of the Holy Spirit in everything I say, do, and write. This glorifies GOD because the boldness is in HIM and is therefore not self-proclaimed. Bottom line: You remain pathologically untruthful just as dearly departed Bob Pastorio was untruthful: http://HeartMDPhD.com/Convicts/Bob Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/PressRelease Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com Bondservant to the KING of kings and LORD of lords. > In article <1190833490.969362.128...@n39g2000hsh.googlegroups.com> "Andrew B. Chung, MD/PhD" <heartdo...@emorycardiology.com> writes: > [quoted text clipped - 35 lines] > Are you saying that routinely eating more than two pounds a day > will inevitably lead to heart disease? Heart weight should have everything to do with it. Shouldn't the allowed amount be adjusted for net cardiac mass, as determined by a CAT $can? Tour de France level cyclists have maybe 50% more heart muscle. Shouldn't they be allowed THREE pounds of food per day? > > In article <1190833490.969362.128...@n39g2000hsh.googlegroups.com> "Andrew B. Chung, MD/PhD" <heartdo...@emorycardiology.com> writes: > > [quoted text clipped - 41 lines] > more heart muscle. Shouldn't they be allowed THREE pounds > of food per day? Ah, but you see, this diet (tinad) was initially inspired by a documentary on Everest climbers -- extereme athletes, in a sense -- who got by on even less (albeit briefly: you really don't take five years to climb Everest. Not alive, anyhow) Of course every foodstuff climbers carry is dehydrated as far as is possible, so I think Andrew's diet (tinad) clearly needs to be modified to specify two pounds of food a day -- before reconstitution. How many calories in two pounds of dehydrated yak butter? I'm estimating around 7500 - 8000. Of course, if all you're really after is the buttery taste, you could replace that with two pounds (~925 ccs) of 2-3 butanedione. -- cary Our armchair disembler opined: > I have heard many a health care professional state that > a high level of fitness reduces the likelihood > of cardiovascular disease. Do you dispute that? "If a person has been overeating, there will be cardiovascular disease that will not be reversed with exercise." Which is an answer to match another question. A cheap trick often used by polititions. It is a concession by ommission that what the poster was told is the truth. The ability to reverse cvd in some aspects has the jury out still when it comes to exercise. Many of the risk factors and symptoms and related factors can be reversed by exercise. For example vat can be selectively reduced by exercise and speeds reduction when calorie reduction is added. God bless. > Cardiac Rehab Underutilized > [quoted text clipped - 22 lines] > > http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001800/frame.html Many thanks for this info. The first link will take me a bit of time to get through. Your final paragraph, which is mentioned in the second link, about reducing mortality by 27%, is incredible. In the UK, we have the National Health Service (NHS). In my experience, the standard can be very good. However I have found that with my rehab I have had to take the initiative on several occasions, otherwise either things might not have happened or would have happened very slowly. In my area of London funding has been low and so the cardiac rehab was slow to happen. I have been waiting 10 months for the physical rehab to happen. It is really good - pushing the group while under control. What I found difficult to believe is that there should be 13 people in the group, yet only 4 are turning up! Apparently around 40% turnout is not unusual. I wonder if I might be unusual in trying extend my life while maintaining a reasonable quality. Before my MI I smoked and exercised maybe once or twice a year, after having been very fit previously. My MI was a real wake-up call and my life style has now changed dramatically. I am now in a better position to monitor myself and know better what resources to tap for my rehabilitation. But I can see how people could get left behind in the rehab programme. I look forward to reading the first .pdf document. Thanks, Iain MarilynMann <mannm@comcast.net> wrote in part: >An earlier meta-analysis concluded that the exercise portion of >cardiac rehabilitation can reduce mortality by 27%. I haven't read the analysis (yeah, yeah, I know), but I doubt that randomized controlled trials were done. And if not, it would be impossible to say much. I imagine the patients that got referred to rehab had better doctors and were better-motivated patients. -- Jim Chinnis Warrenton, Virginia, USA |
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