Cardiac patients of Northside Hospital Cherokee are completing rehabilitation in-home and virtually, still focusing on structured exercise, patient counseling, and nutrition and lifestyle education.
Patients who qualify for the cardiac rehab program have had a cardiac event such as a heart attack, stints, heart or lung transplants, bypass surgery, valve surgery, replacement or repair and stable angina.
“Cardiac rehab is a personalized, supervised program. We go through a plan with a person that is individualized for them,” said Kami Benson, a physiologist at Northside Hospital Cherokee.
Patients were last seen in-person on March 17 and the hospital began implementing the revised program on March 23.
Benson said the physician-referred rehab program involves 36 visits over about 12 weeks, as patients visit three days a week for an hour each session.
“It was very quick that our leadership said we need to keep these patients engaged and we need to help their health progression during this COVID crisis,” Benson said. “Our goal is to increase life expectancy and reduce their chances of any further cardiac events.”
The rehab program transitioned to a three a week program with two virtual educational days and one virtual exercise class. All patients were sent home with a home exercise packet and Dyna bands the first week of the transition, and Powerpoint’s and pdfs are also sent after each virtual class.
“We wanted them to have something to use as a guide at home,” Benson said.
Richard Cook, a Northside Hospital Cherokee cardiac rehab patient, said the at-home program has not been without adjustments.
“I think it is the best they can do under the circumstances,” he said.” I do miss the exercise equipment there…everyone has had to improvise. Instead of the exercise sessions I would be having there, I try to do the same amount here.”
Benson said the patients have done well, overall.
“I like to open up the class about 10 minutes ahead of time…so we can talk,” Benson said. “One of my favorite things is the feedback, I have had a few people say they really appreciate this — it really helps them out and it gives them a schedule to keep to and maintain.”
Cook had similar sentiments about the extra time before classes.
“We are able to talk back and forth, ask questions and we are able to exercise along with them,” he said. “I think they have done a wonderful job with what they have had to work with through this pandemic.”
For those not wanting or able to do a virtual program, Benson said packets are mailed and emailed each week.
“We are doing a little bit of everything. Not everyone is technical savvy, so these go-to meetings are not for everybody,” Benson said. “We are answering calls and calling our patients, so we are still trying to engage them and help with their progression.”
Cook, who had a heart attack in October and had stents put in, was halfway through his rehabilitation when the transition to a virtual program occurred mid-March.
“This really came up on everyone suddenly and I know that the hospital and staff had a lot put on their plate all at once,” Cook said. “I think they have certainly made the best they could out of the situation.”
Benson said the cardiac program is split into two phases. Phase two is a monitored program, while phase 3 is unmonitored where patients can come as long as needed.
The program focuses on behavioral and psychosocial health, refers to a dietician and works alongside Northside Cancer Institute.
“We look at the patient as a whole, not just their cardiac event, but how is everything else going,” Benson said. “It really incorporates a big circle of encompassment of everything for that patient.”
Benson also said physicians are provided with daily reports to the patients’ electronic medical record and patients, any time they go to their doctor, receive a multi-session report on their progress to date.
“We are still here as a resource for our patients as much as we can be,” Benson said. “We are doing phone calls, emails, mailings and the go-to webinars — that is how we are keeping up with our patients right now.”
Following the shelter-in-place guidelines, high-risk patients including cardiac, pulmonary and those 65 years old and above will not be allowed to return to in-person rehab until June 12.
“At that point, we are looking for a reopening date after that date, when it will be safe and acceptable for patients to now come back into a group type setting,” Benson said.
Benson said Northside Hospital Cherokee is looking at changes as a whole.
“What can we do in the future to be more progressive? Is there a hybrid-type cardiac rehab we could do,” Benson said. “We are definitely working toward trying to get a little bit more technical savvy and getting a lot of things online.”
Benson said they are looking at a program that incorporates in-person cardiac rehab and at-home work using powerpoint and educational handouts.
“They have kept me on track, sent out exercise logs that we have been trying to keep up with and keep track of exercise we are doing, the right amount recommended by our cardiologists,” Cook said. “I have appreciated the work they have put into it. I think it has helped keep people healthy.”
Benson said the percentage of patients who participate in cardiac rehab that can is low, with approximately one-third participating who have have cardiac events and only 16 percent of medicare patients participating.
For those that complete the program, they have a 40 to 47 percent reduction of a further cardiac event happening within the next four to five years, according to Benson.
“That’s one of the main things why cardiac rehab is so important,” Benson said. “It is a really small percentage of patients who take the benefits of cardiac rehab. We really want to make those patients aware of what services are out there and how to keep them strong, healthy and live a wonderful, long life.”