Phase I cardiac rehabilitation

Phase I, which in most cases is the initial stage of the patient's cardiac rehabilitation pathway, is considered as the in-patient stage, or after a 'step change' in the patient's cardiac condition. These step changes include myocardial infarction, onset of angina, any emergency hospital admission for coronary heart disease, cardiac surgery or angioplasty and/or stent, and first diagnosis of heart failure (SIGN, 2002).

Following an acute coronary event, phase I CR is important in assisting the patient's pathway to recovery. The National Service Framework for CHD (DoH, 2000) states that the aim of this phase is to offer high-quality CR before discharge from hospital, and this should begin as soon as possible after someone is admitted with CHD. Phase I will be the patient's first point of contact with the CR team, and this introduction to CR may favourably or adversely influence their perception of secondary prevention. At this stage, the patient may be anxious and depressed regarding the threat to their health (SIGN, 2002). An important aspect of phase I CR is to allay these fears and promote positive outcomes for both the patient and their significant others (Thompson, 1989).

Content of Phase I Cardiac Rehabilitation

The content of phase I CR has traditionally included assessment, education and exercise/mobilisation. There is an emphasis on reassurance and the positive aspects of recovery post-ACS, revascularisation or other CHD-related admission, specific to each individual. Partners and/or significant others are also involved (SIGN, 2002). Assessment involves identifying risk factors and risk stratification, with the educational aspect providing patients with appropriate individual information regarding CHD, risk factors and lifestyle (BACR, 1995). Mobilisation may include graduated exercise, walking programmes and stair practice.

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