Cardiac Rehabilitation for Secondary Prevention of Cardiovascular Diseases

Abstract

Outpatient cardiac rehabilitation programs provide supervised exercise training in conjunction with other secondary prevention interventions. They are designed to speed recovery from acute cardiovascular events such as myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, angina, heart failure, heart transplant and after heart valve procedure to improve quality of life1. Aortic Stenosis is one of the most common types of valvular heart disease in elderly with reported prevalence as high as 12-26%2. The most common etiology of mitral stenosis is rheumatic heart disease; however, it is not common that the disease remains undiagnosed up until an advanced age. Functional mitral stenosis related to massive annular calcification and reduced leaflet excursion has been reported in 2.5-18.0% of elderly patients. Mitral regurgitation is the most frequent valvular heart disease in patients over the age of 65 years. Elderly patients account for about 40% of all patients with mitral regurgitation and 4.5% are over 80 years of age. Mitral valve diseases are increasing in prevalence and require valve replacement in severe diseases. Patients after mitral valve procedure do go to cardiac rehabilitation but minimal clinical studies have done to show magnitude of benefit for cardiac rehabilitation in this patient population. Randomized clinical trials have shown improvements (both physical and psychological) in patients undergoing cardiac rehabilitation after aortic valve replacement, so we compared mitral valve patients with them to see any benefits. We evaluated baseline exercise capacity and psychological well-being for mitral valve patients participating in cardiac rehabilitation and compare physical and psychological outcomes between mitral valve and aortic valve patients. In our 2nd paper we discussed importance of guideline directed medial therapy in cardiovascular diseases. As cardiac diseases are the most common cause of morbidity and mortality in USA, it is important to diagnose and treat effectively for secondary prevention of cardiovascular diseases. Patients with coronary artery disease & congestive heart failure need to be on guided medical therapy for recovery from primary event as well as for prevention of further cardiovascular events. Cardiac Rehabilitation programs have shown improvements in secondary prevention of cardiovascular events; however, no clinical studies are available to show prevalence of guideline directed medical therapy in this patient population. Also, we can identify predictors of better medication prevalence in patient with coronary artery disease and heart failure.