About Cardiovascular & Pulmonary Rehabilitation

Click Here for Cardiac Rehabilitation Fast Facts

  • Click Here to download a PDF of the Cardiac Rehabilitation Fact Sheet. Feel free to personalize this with your program's contact information and distribute it to your patients!
  • Click Here to download the Cardiac Rehabilitation Fact Sheet in Spanish!
  • Click Here to download a PDFof the Cardiovascular Rehab FAQs (also found below).
  • Click Here to download the presentation entitled "Cardiac Rehabilitation: An Underutilized Class I Treatment for Cardiovascular Disease. " This PowerPoint® presentation was developed by AACVPR leadership and provides a comprehensive overview of cardiac rehabilitation, including ACC/AHA Guideline Recommendations for referral to cardiac rehabilitation and the evidence supporting these guidelines.

Click Here for Pulmonary Rehabilitation Fast Facts

  • Click Here to download a PDF of the Pulmonary Rehabilitation Fact Sheet. Feel free to personalize this with your program's contact information and distribute it to your patients!
  • Click Here to download a PDF of the Pulmonary Rehab FAQs (also found below).

Click Here to download the National Quality Forum's "Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination: A Consensus Report"


Cardiac Rehabilitation Fast Facts

What is Cardiac Rehabilitation?

Cardiac rehabilitation is a medically supervised program designed to optimize a cardiac patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing death and disability.

Who benefits?

Patients with a history of:

  • Myocardial infarction (heart attack)
  • Coronary artery bypass graft surgery (CABG)
  • Current stable angina pectoris
  • Heart valve repair or replacement
  • Percutaneous transluminal coronary angioplasty (PTCA)/ or coronary stenting
  • Heart or heart-lung transplant
  • Heart Failure and those with ventricular assist devices
  • Coronary artery disease equivalents such as diabetes or peripheral artery disease
  • Patients with diabetes
  • Peripheral arterial disease

 April 2012 - Randal Thomas, MD, Past President of AACVPR and Director of Mayo Clinic's Cardiovascular Health Clinic, and colleagues found that patients who participate in cardiac rehabilitation after having heart interventions such as angioplasty, stents and clot-busting drugs have a 45-percent lower mortality rate. The research team studied data from over 2,300 patients between 1994 and 2008, and recently published the results in Circulation.

Click the play button to view a video interview with Dr. Thomas and his colleagues about the results of this important research.

 

 


Components of Cardiac Rehabilitation

Cardiac rehabilitation is tailored to meet the patient’s individual needs and goals.  The Centers for Medicare and Medicaid Services (CMS) guidelines are based on the core components of cardiac rehabilitation and direct that the following components be included in a program:

  1. Physician prescribed exercise: Exercise training and other therapeutic exercise including aerobic and strength training.
  2. Cardiac risk factor modification: Includes education, counseling, and behavioral intervention; related to the individual’s care and tailored to the individual’s needs. It may include a combination of one or more of the following.
    • Physical Activity
    • Nutrition
    • Lipid management
    • Blood pressure management
    • Smoking cessation
    • Weight management
    • Diabetes management
    • Psychosocial management
  3. Psychosocial Assessment: Evaluation of the individual’s mental and emotional functioning as it relates to the individual’s rehabilitation or cardiac condition.
  4. Outcomes Assessment: Evaluation of the patient’s progress as it relates to the individual’s rehabilitation goals and program.

An Individualized Treatment Plan (ITP) is also a required element that describes the individual’s diagnosis, the type, amount, frequency and duration of the items and services under the plan and the goals set for the individual under the plan. The plan is written, established, reviewed, and signed by a physician every 30 days.

Evidence Supporting Cardiac Rehabilitation

Cardiac rehabilitation is now a Class I Indication in clinical guidelines for:

  • Myocardial infarction (MI)
  • Percutaneous Coronary Intervention (PCI)
  • Coronary artery bypass grafting (CABG)
  • Angina
  • Heart failure
  • Valvular heart disease
  • Peripheral arterial disease (PAD)

The Performance Measures Set 1 (referral to CR from both an inpatient and outpatient setting) has been endorsed by the National Quality Forum (NQF).

The demonstrated evidence-based benefits of Cardiac Rehabilitation include the following:

  • 20-30% reduction in all-cause mortality rates
  • Decreases mortality at up to 5 yeasr post participation
  • Reduced symptoms (angina, dyspnea, fatigue)
  • Reduction in nonfatal recurrent myocardial infarction over median follow-up of 12 months
  • Improves adherence with preventive medications
  • Increased exercise performance
  • Improved lipid panel (total cholesterol, HDL [good cholesterol], LDL [bad cholesterol], and triglycerides)
  • Increased knowledge about cardiac disease and its management
  • Enhanced ability to perform activities of daily living
  • Improved health-related quality of life
  • Improved psychosocial symptoms (reversal of anxiety and depression, increased self-efficacy)
  • Reduced hospitalizations and use of medical resources
  • Return to work or leisure activities

Quality Cardiac Rehabilitation Programs

Since 1998, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) has certified programs in order to recognize programs that were meeting the standards put forth in the published Guidelines for Pulmonary and Cardiac Rehabilitation. Once a program is certified, it can recertify every three years. Click Here to learn more about the certification and recertification process.

Find a Cardiac Rehabilitation Program

Click Here to search for a Cardiac Rehabiltation program near you!

Reimbursement

Medicare and most private insurance carriers will reimburse for cardiac rehabilitation. Medicare has specific requirements when billing and there is some variation depending on local coverage determinations. For more specific information, view the Health and Public Policy page.

CMS Current and Future Utilization of CR Referral Measures

CMS has contracted with NQF to review and endorse performance measures for CMS to use. AACVPR is working to get CMS to adopt the inpatient referral measure as a core measure.

Resources for Cardiac Rehabilitation

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Pulmonary Rehabilitation Fast Facts

What is Pulmonary Rehabilitation?

The American Thoracic Society (ATS) and European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation defines Pulmonary Rehabilitation as “an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily activities.  Integrated into the individual treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease”.

Who Benefits?

Patients with chronic obstructive pulmonary disease (COPD) make up the majority of patients who are referred to Pulmonary Rehabilitation programs.  However, studies also show that pulmonary rehabilitation may be beneficial in any patient with respiratory symptoms that result in diminished functional capacity or decreased quality of life.  This would include patients with not only obstructive lung diseases but also patients with restrictive lung disease such as interstitial lung disease and patients with neuromuscular diseases.

Components of Pulmonary Rehabilitation

Pulmonary rehabilitation is tailored to meet the patient’s individual needs and goals.  The Centers for Medicare and Medicaid Services (CMS) guidelines are based on clinical practice guidelines and direct that the following components be included in a pulmonary rehab program:

  1. Physician prescribed exercise:  includes techniques such as exercise conditioning, breathing retraining, step and strengthening exercises.  Some aerobic exercise must be included in each pulmonary rehabilitation session.
  2. Education or training:  Must be closely and clearly related to an individual’s care and treatment and be tailored to the individual’s needs.  This includes nutritional counseling.
  3. Psychosocial Assessment:  Evaluation of the individual’s mental and emotional functioning as it relates to the individual’s rehabilitation or respiratory condition.
  4. Outcomes Assessment: Evaluation of the patient’s progress as it relates to the individual’s rehabilitation goals and program.

An Individualized Treatment Plan (ITP) is also a required element that describes the individual’s diagnosis, the type, amount, frequency and duration of the items and services under the plan and the goals set for the individual under the plan.  The plan is written, established, reviewed, and signed by a physician every 30 days.

Evidence Supporting Pulmonary Rehabilitation

The demonstrated benefits of Pulmonary Rehabilitation include the following:

  • Reduced respiratory symptoms such as dyspnea and fatigue
  • Increased muscle strength and endurance
  • Increased knowledge about lung disease and management
  • Increased ability to perform tasks of daily living
  • Increased quality of life
  • Decreased depression and anxiety
  • Reduced pulmonary exacerbations and decreased use of medical resources
  • Ability to return to work or leisure activities

Quality Pulmonary Rehabilitation Programs

The AACVPR instituted program certification in 1998 to recognize programs that meet the published Guidelines for Pulmonary and Cardiac Rehabilitation. These guidelines reflect the standard of care for programs and are regularly updated. Programs can document their adherence to these nationally developed guidelines by undergoing the review process to become certified, and then recertifying every three years. Those applying for certification or recertification are also required to complete an extensive checklist related to the daily operation of their program. Click Here to learn more about the certification and recertification process.

Find a Pulmonary Rehabilitation Program

Click Here to search for a Pulmonary Rehabilitation program near you!

Reimbursement

Medicare and most private insurance carriers will reimburse for Pulmonary Rehabilitation.  Medicare has specific requirements which must be met when billing for COPD patients.  Billing and reimbursement for non-COPD patients will vary depending on local coverage determinations.  For more specific information, view the Health and Public Policy page.

Resources for Pulmonary Rehabilitation 

  • ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Guidelines. Chest 2007 [CHEST 2007; 131: supplement 5]
  • American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation
  • Executive Summary: Global Strategy for the Diagnosis, Management, and Prevention of COPD Revised 2006. Peer-reviewed summary of GOLD recommendations for the diagnosis, management, and prevention of COPD Am J Respir Crit Care Med 2007;176:532-555.
  • American Thoracic Society and the European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med; 2006
  • AACVPR, Guidelines for Pulmonary Rehabilitation Programs. 3rd ed. 2004, Champaign, IL: Human Kinetics Publishers.

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