Phase I Cardiac Rehabilitation

Phase I is the in-patient stage and includes medical evaluation, reassurance and education, correction of cardiac misconceptions, risk factor assessment, mobilisation and discharge planning SIGN (2002). Risk stratification should begin at this stage (see Chapter 2).

For patients post-MI, the site and size of the infarct can affect prognosis. Anterior infarcts often result in greater left ventricular dysfunction (BACR, 2000), and, as a consequence, exercise tolerance may be limited. Progression should vary according to the stability of the patient's condition during recovery, with higher risk or more debilitated patients progressing more slowly than lower risk, uncomplicated ones (AACVPR, 1999).

Previously, patients were often kept on bed rest for many weeks following a cardiac event. However, it is now recognised that prolonged period of immobilization can lead to deep vein thrombosis, pulmonary embolism, de-conditioning, increased anxiety and depression (BACR, 1995). Over the years the period of bed rest and length of inpatient stay has gradually reduced. Patients post-MI are commonly allowed to sit up after a short period of bed rest, e.g. 12 to 24 hours (AACVPR, 1999).A prolonged period of bed rest may be required for patients who are haemodynamically unstable, or for those who have suffered shock, heart failure or serious arrhythmia.

Initial discussion about the patients' subjective description of their symptoms is important and patients should be encouraged to monitor for any adverse symptoms. Medical staff should be informed by the patient of any activity at phase II and receive the support they require. Social support from those at home is important and can improve prognosis by providing emotional support and sustaining activity and other healthy lifestyles (Yusuf, et al., 2003).

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