by Margo A. Ragan
Come with me, dear reader, as we imagine the following scenario. You are a very busy individual, perhaps the editor of a popular regional magazine. Or, you are a sales executive, juggling the demands of a family and a calendar of business appointments that could translate into month end commissions. You have promised yourself a membership in the local fitness center, but you are too busy, too tired, too stressed, too broke—you fill in with the appropriate adjective.
Traveling to and from work on I-95 is fraught with traffic challenges so you try to relax on the road with a cigarette or two, a habit you have on your bucket list to quit but haven't tackled yet. Since you are late getting home for dinner, you stop at a fast food restaurant to pick up a bucket of fried chicken, wings, or maybe your favorite, a Philly cheese steak with French fries and onions. Tomorrow you plan to eat only salads and soups because most of your slacks are already too tight.
Now you are lying in a hospital bed, staring at the ceiling trying to remember how you got here. You remember some discomfort in your chest, breaking out into a cold sweat, having trouble breathing, being lightheaded. Someone had yelled, “Call 911”, and that is all you remember.
According to the American Heart Association, you may have had a myocardial infarction, or in terms we quickly understand, a heart attack. The Center for Disease Control and Prevention asserts 1.5 million heart attacks occur in the United States, resulting in 500,000 deaths annually.
Do I have your attention yet? There is really great news for anyone who has had a cardiac event. Thanks to technology and the high caliber of services offered by medical institutions in their cardiac rehabilitation units, survival rates have steadily improved, according to the Journal of the American Medical Association. We in the Delaware and Lehigh Valleys are very fortunate to have cardiac rehabilitation units that adhere to the highest standards of cardiac rehabilitation care. They are staffed by professionals who are dedicated to helping individuals return to a healthy heart life style; moreover, all the individuals interviewed for this article were positive and proactive in their approach to patient/client care. The programs are credentialed and ranked among the top facilities in the nation; given the restraints of this article, I focused on one singular aspect of each program.
Melanie Breslin is the Nurse Manager of the Cardio-Pulmonary Unit, St. Mary Medical Center in Langhorne, PA. She or a member of her staff will be among the medical persons a cardiac patient will see while in the hospital setting. “We are part of a multi-disciplinary team, that consists of physicians, nurse practitioners, physical therapists, case workers, who develop a medically supervised program to help improve the health and well being of this person who has just had a cardiac event.,” explained Melanie.
Initially, her first concern is to allay patient fears about what has happened. Many patients do not have an understanding of what cardiac rehabilitation can do, and may not know the benefits to be obtained from their participation. “During phase one of the rehab process," said Melanie, “we explain how our program goals are to strengthen the heart and review what the individual can do to prevent another occurrence. Oftentimes, family members are present and we address their concerns too.”
Educating the entire family about a cardiac event is as important as educating the patient. “If a family member is anxious, that energy is transmitted to the patient," Melanie informed. "We encourage family participation in all our education sessions in Phase 2, which is the monitored rehabilitation process.”
During phase 1 the rehabilitation process may include a therapist assisting a patient getting in and out of bed, or aid in taking his first steps. Phase 2 takes place in the rehab unit itself. St. Mary's unit can accommodate 16 clients in an hour, all wearing a heart monitor while exercising so that the staff has instant information regarding the client's welfare. Patients who are in Phase 2 have had their event within the past year.
“There is a correct way to exercise for anyone with heart issues,” said Melanie. “Our nursing staff all have intensive cardiac case experience, and work with our certified physical trainers to partner with our clients toward a healthy life style result.”
Once the client has completed the 12-week program, he or she is eligible to proceed to a Phase 3 segment, which is maintenance. The monitored program is available on Mon-Wed-Fri, while Phase 3 is available on Tues-Thurs. Staff is available for the entire program.
“A benefit of St. Mary is that we offer a Wellness Center, that is not related to the cardiac rehabilitation program per se. The Center is located on a floor directly above the rehab unit, so in case of emergency, we are available immediately,” Melanie said.
She has worked with the cardiac rehabilitation program for four years, and enthusiastically endorses the education programs in which the staff participates. “We continue to grow, learn and update our skills with current technology,” she said. “St. Mary has been certified by the American Association of Cardiac Vascular Pulmonary Rehabilitation.”
Dave Martens is the Clinical Manager of the Cardiac Rehabilitation Department, Doylestown Hospital, Doylestown, Pennsylvania. “One of the aspects of our program is that we have a large staff which enables us to do more with our patients," Dave informed. "We work with the patient before, during, and after an appointment."
Dave cites many benefits to this approach. His staff learns about the patient as an individual, and in return, the patient develops a stronger sense of trust in the rehabilitation program.
Because Dave has wanted to be more specific in patient care, he worked in coordination with Doylestown Hospital's Management Information Systems department to create their own software system. "Previously we have purchased software that did not give us all the information we wanted and needed," Dave said. "Now our software works with Microsoft spreadsheets enabling us to link on to multiple sources and tasks. This information helps us serve our patients more effectively and efficiently."
Thomson Reuters recently cited Doylestown Hospital as one of the nation's top 50 cardiovascular hospitals. “As a result, we draw from a population that extends outside of our immediate area,” Dave said. “Our technology helps us keep track of our patients, and gives accurate information to our Quality Management assessment.”
Aria Health network consists of three community hospitals, two of which have cardiac rehabilitation units. The Aria Bucks hospital is located in Langhorne, and the Torresdale Aria is in Northeast Philadelphia. Sue Stahl is manager of both units.
In 1995 the Agency for Health Care Policy and Research established Clinical Practice Guidelines for Cardiac Rehabilitation. With those guidelines in mind, Sue has developed an education program to help people to learn how to live with heart disease in a healthy life style. The government was saying that exercise by itself is not going to change behavior and was asking the medical profession to educate more because knowledge is power. “Especially with individuals who are experiencing their first cardiac event, there is a high degree of apprehension,” Sue said. “Our education program seeks to teach before or after their physical rehabilitation sessions, as well as in group sessions, always with the mission of guiding patients toward choosing a healthier life style.”
Among the topics Sue and her staff cover, is the matter of learning how to shop in a healthy way. Sue has a multitude of labels, and staff goes to great lengths to teach how to read a label correctly. "Often, people do not know the difference between salt and sodium," she informed. “Or they do not realize the impact of the different kinds of fats, which ones are good to consume, which ones they should avoid.”
Her main goal is to empower patients with knowledge about what they can do as individuals to take control of their lives. “When a person is in the hospital in what we call Phase 1, he or she may feel powerless. In Phase 2, the patient has the opportunity to be in control of his own destiny. That fact by itself is healing.”
Sue and her staff work on establishing a personal relationship with their patients. By doing so, they are able to reach those patients who may be resistant to further cardiac rehabilitation programs. “Once a patient understands how helpful and important this information is to their quality of life, they are converted in making the right decisions about their disease,” she said.
Karen Halm, R.N., is the Director for the Cardiac Rehabilitation Program for Abington Hospital, Abington, PA. Their cardiac rehab unit is quite large, 800 sq. ft. and is located near their Fitness Institute, at 8000 sq. ft. "We tell our patients, if you fall down, we are there to pick you up,” she said. “That reassurance helps them feel safe and secure at a time in their lives when they fear their lives are in jeopardy.”
The rehab unit has a variety of modern, state of the art equipment, including several treadmills and bicycles. Before a person gets on any piece of equipment, he is given instruction by a certified professional who monitors the exercise. “When I started in this phase of my profession, many people did not regard the value of exercise as we do today," she informed. "That attitude has changed significantly.” She attributes that change to media education about exercise, and a better acceptance of exercise as a part of the healing process.
The rehab unit is seeing more and more people in their thirties and forties who are coming for help. Sue credits the advances in technology and education for this. “Today the medical profession is able to identify heart disease much earlier, long before a catastrophic event happens to a person,” she said. “Younger adults seem to be more acquiescent to learning how to exercise correctly. Women too are being diagnosed earlier, so our unit at any one time has a cross section of ages and gender.”
When Karen began her career in cardiac rehabilitation in 1987, the program had structured assignments. “I found that when I made the education schedule more flexible, allowing patients to come in on their own time constraints, they were more amenable to the program,” she said. “With diet, exercise, and education, a cardiac patient can lead a healthy life.”
Abington Hospital is a Blue Distinction Center for Cardiac Care, a nationwide designation program of the Blue Cross Blue Shield Association.
Darlene Garon is a Site Coordinator for the Cardio Pulmonary Program within the Lehigh Valley Health Network. That network includes rehabilitation units in Lehigh Valley-Muhlenberg and Cedar Crest hospitals. The Lehigh Valley network is rated as being in the top tier of Regional Hospitals in the Lehigh Valley Metro Region by US News and World Report.
“We use a multi-disciplinary team approach to cardio rehabilitation," offered Darlene. "Our cardio-vascular physicians make the referral, and we see ourselves as extensions of their care. The program consists of phase 1: hospital setting, phase 2: monitored rehabilitation, phase 3:maintenance, and phase 4: Medical Fitness Program which is designed for those patients who have completed the other three phases and wish to continue work on their own.”
When patients come to the rehab unit for orientation, Darlene conducts an extensive interview. During this time she is alert for signs of depression, difficulty with coping with their diagnosis, or perhaps confusion about what is going to happen in rehab. “I am part of a team, working collaboratively to ensure client health,” said Darlene. “Our unit is in correspondence with the attending physician, and we conduct a comprehensive review every thirty days.”
Darlene acknowledges that it takes time to establish a life long habit of exercise. “Change is difficult," he said, "but working as a team as we do is enormously helpful to the client.”
Lehigh Valley offers a Positive Life Style Program for clients who are at risk for cardiac events, or are diabetic. There are many issues affecting these people. Notably, the phase 2 portion of the rehabilitation program is one, which has insurance reimbursement for certain diagnosis. If a person has not had a recent cardiac event or diagnosis, then the Positive Life Style Program is offered. It allows these individuals to come into a medically supervised program, where they can then transfer into a maintenance program. Darlene welcomes telephone inquiries on the program at 610-402-5915.
St. Luke University Health Network is a multi-hospital system serving the greater Lehigh Valley, and offers cardiac resources at all locations. Thomson Reuters named St. Luke's as being among the top 50 cardiovascular area hospitals in 2012, and William Merkert, M.S., Cardiac Rehabilitation Specialist is one of the many health care professionals who makes it happen.
William frames the goal of cardiac rehabilitation within its proper context. "Our program is a combination of health exercise and meaningful education, and we are a vital extension of the medical care our patients need," he explained. “Our hospital network has distinguished itself in reducing the extremely important door-to-balloon time, which is the time a person with a cardiac event enters the hospital to the catherization laboratory. We are significantly lower than the national average.”
William focuses on behavior modification that can help the clients make the necessary life style changes. "One of the purposes of our first meeting with the client is to hear their view on their cardiac event. We ask for their feelings, experiences, needs and goals," he said.
His purpose is to actively draw the client into the rehabilitation process, so that the client is an active participant in a team that includes physicians, caseworkers, and physical therapists. The more the client is engaged, the higher the likelihood that negative behaviors will be modified.
“The bottom line is that our goal is to help our clients get heart healthy,” William concluded, “and we have the services to get to that goal.”
Margo Ragan is a freelance writer and lecturer at Holy Family College who lives in New Hope, PA.