Assessment and needs

Assessment must be carried out on an individual basis, examining each patient's personal requirements and risk factors and then producing individual tailored plans to meet these needs. The current guidelines (BACR, 1995; DoH, 2000; SIGN, 2002) generally agree that the following are addressed:

• risk stratification and lifestyle modification, as appropriate;

• educational requirements;

• psychological factors, including anxiety and depression;

• needs of significant other(s);

• social, vocational and cultural needs.

Before discharge from hospital patients should be offered, as an integral part of acute care, the following:

• assessment of physical, psychological and social needs for future CR;

• negotiation of a written individual plan for meeting these needs;

• prescription of effective medication, and education about its use, benefits and side effects;

• involvement of relevant informal carer(s);

• provision of information about cardiac support groups;

• provision of locally relevant, written information about CR.

The key elements of phase I include medical evaluation, reassurance, education regarding CHD, correction of cardiac misconceptions, risk factor assessment, mobilisation and discharge planning. In addition, the use of psychological measurement is recommended, using, for example, the hospital anxiety and depression scale (HADS) (Zigmond and Snaith, 1983).

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