Case Report : Asan Medical Center Cardiac Rehabilitation AACVPR (http://www.aacvpr.org/) KACVPR (http://www.kacvpr.com/)
Backgrounds
PCI 2,395 consecutive patients in Minnesota (Mayo Clinic) Between1994 and 2008 Propensity score-matched analysis Propensity score stratification Regression adjustment with propensity score in a 3-month landmark analysis Median 6.3 years CR participation : 40% of patients Circulation. 2011;123:2344
PCI Relative mortality reduction (47%) Circulation. 2011;123:2344
CABG Patient mortality in the 12 years following enrolment into a pre-surgical cardiac rehabilitation programme. Mortality 19% reduction Clin Rehabil. 2011 Dec 15. [Epub ahead of print]
Stable Coronary Artery Disease 1 native coronary artery stenosis of 75% by visual assessment amenable to PCI 12 months of exercise training (20 minutes of bicycle ergometry per day) Circulation. 2004;109:1371-1378
Stable Coronary Artery Disease Clinical events (stroke, target vessel revascularization, PCI of a de novo lesion, or CABG) 88% 70% Circulation. 2004;109:1371-1378
Acute Coronary Syndrome 18,809809 patients OASIS 5 randomized trial Circulation. 2010;121:750-758.
Acute Coronary Syndrome Circulation. 2010;121:750-758.
The dose of cardiac rehabilitation Death MI 47% 22% 14% 31% 23% 12% Dose-response relationship!! Circulation. 2010;121:63-70
Peripheral Artery Disease Circulation 2012;125
Practice
PCI or CABG without comprehensive risk factor modifications is a sub-optimal therapeutic strategy. Psychosocial C Counseling li
Ideal Member Program Director Medical Director
Members
Target Population ALL suitable CHD patient Stable angina ACS ( UA, STEMI or NSTEMI following medical or surgical management.) Before and After revascularisation. Stable heart failure and cardiomyopathy Peripheral vascular disease Following valve surgery or ICD insertion High risk patients for primary prevention
Components Lifestyle - Physical activity and Exercise - Diet and Weight management - Smoking Cessation Education Exercise & fitness Risk Factor Management - Hypertension - Diabetes - Dyslipidemia -Smoking - Obesity Psychosocial stress management Cardio-protective drug therapy Long Term Management
Credibility
Flow, First Step Second Step (ITP) (A,B,C,D),, Third Step
Determinating factor 100 Risk factor MI LM CTO Multivessel(CABG) / / HF
Basic Program Flow F/U CV (1 st ) 2 A~D Model 14 CS (1 st CS ) 4 (2 nd CS ) A~D Model 16 (3rd CS ) HF (1 st HF ) 4 (2 nd HF ) A~D Model 16 (3rd HF )
Flow (ITP) (12 ) ) Feedback,, (, ) (fitness)
Education
Education and Consulting
Exercise
ITP
Participation Participation Participation Participation 90 100 (%) 60 70 80 centage ( 20 30 40 50 ment perc 0 10 20. 4.. 6. 7. 8. 9. 0.. 2.. 2.. 4 5 6 7 8 1 1 2 1 2 3 Enrollm 2010.3 2010.4 2010.5 2010.6 2010.7 2010.8 2010.9 2010.10 2010.11 2010.12 2011.1 2011.2 2011.3 2011.4 2011.5 2011.6 2011.7 2011.8 2011.1 2011.11 2011.12 2012.1 2012.2 2011.3
Factors influencing a patient s decision Main reasons distance to the CR center patient s belief they could handle their own problems lack of time cost of rehabilitation deficient belief of health providers - Importance of raising i patients t belief they could Eur J Prev Cardiolog. 2012 Jan 20
Factors influencing a patient s decision Asan Medical Center s Experience..??.?....
Real Achievement Rate CV A B C 122 207 596 FU 93 129 403 76% 62% 68% CS A B C 12 6 3 FU 6 3 3 50% 50% 100% HF 46 FU 28 61%
Case Report M/45 Present illness : 10 1~2 prolonged chest pain 119 cardiac arrest CPCR, STEMI primary PCI at plad with POBA CCU, 1 chest pain CAG POBA site restenosis bare-metal stent t (Jo stent t 2.5X16). 1 stent site POBA. 4 POBA. 10 Risk Factor : DM/HTN/Hyperlipidemia/smoking Risk Factor : DM/HTN/Hyperlipidemia/smoking Obesity (91Kg 173cm)/Sedentary life ( )
Case Report
Determinating factor DM,HTN,Hyperlipidemia,smokig Poor exercise, OK Type A Multi-vessel ( )
Case Report (Outcome) Variables Before After VO2 max (ml/min) 1632 2742 Body Weight 91Kg 72.4 Kg HbA1C 9.2% 6.0% T-chol/LDL 235/128 154/79 BDI 15 2 WHOQOL 67 88 Symptom + never
Summary Inevitable new wave in Korea Really, valuable and necessary action for disease control Individualized Treatment Plan (ITP) Multidisciplinary team approach Shed a light on what we will do for patient Just Do It!!! Needs enormous effort, dedication, and commitment, but in the end, its benefits are well worth the struggle.