Scott Webb (Host): There are many benefits to cardiac rehabilitation for stroke and heart patients, and my guest is here today to discuss cardiac rehab, how it works, and how it saves lives. I'm joined today by Dr. Brittany Dixon. She's a board-certified cardiologist chooses to practice at franciscan health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Dr. Dixon it's great to have you back again. Today, we're gonna talk about heart recovery and rehab after a heart attack and you know, after having heart surgery you know a patient may be referred for cardiac rehab, cardiac rehabilitation and I've been to like Physical Therapy before but this is something a little bit different I'm guessing so maybe you could describe cardiac rehab, how long the sessions are, how often do folks go, how many weeks; you know all that good stuff like what's involved in cardiac rehab?

Brittany Dixon, MD: Cardiac rehab is a great resource that we use quite a bit and most hospital systems actually have their own cardiac rehab center attached and that's how useful it is. So what is it? It's supervised exercise program essentially for cardiac patients sometimes for other conditions as well. Essentially what we're doing is we're monitoring their blood pressure and heart rate during the supervised exercise program and also providing you know some education as well so it's all kind of like a comprehensive thing.

So why do we do it? You know for few reasons. At the beginning of the cardiac rehab they'll set goals for each patient and then they'll monitor the patient's progress over time so it helps with recovery after say like a heart attack. It also helps to really increase patient's confidence levels for exercise and i think that's a huge benefit that is underestimated cause I have so many patients who you know may be in the hospital for heart attack or stroke and they scared. They're very scared to get back out there and start being active again and so this really is a way to segue and to show that one it's safe and two prove that they can do it.

So, sessions are typically about thirty minutes to forty five minutes sometimes as long as an hour. They're usually two to three times a week and I would say a typical patient goes for about twelve weeks. Now all of those things can vary based on the individual but that's kind of the standard thing.

 And then when they're there, they're usually doing some form of exercise via treadmill, Elliptical, bike, et cetera. Sometimes they'll have educational classes at different centers and then either way they always gonna be monitored so they occasionally send reports to the referring provider just to show kind of what their heartrates have been, what their blood pressures have been and how they're doing.  

Host: Yeah I see what you mean I, I can really see the value. It makes sense to me and maybe we could just go through like what are some of the benefits? How do patients really benefit from cardiac rehab?

Brittany Dixon, MD: So believe it or not it can save lives. Um, so

Host: Right, yeah.

Brittany Dixon, MD: Um, I think you know, it really does. Long term it reduces the risk of death. It can increase exercise capacity and that's really important especially in patients who've been in the ICU or people who are postoperative. Increases their strength, increases their quality of life they've actually tracked this in many patients. Ah, it's been shown to decrease hospital remissions. Helps manage their habits. Provides education, all of those things. Its pretty widely supported by all of the cardiology groups, the American Heart Association, the American College of Cardiology just because there are so plentiful benefits for cardiac rehab.

Host: In preparation for this Doctor, I went through and I found some stats. I'm pretty proud of myself. So what I wanna do is I want to lay these stats out for you and then have you comment on them because they're really incredible. So cardiac rehab can reduce all cause mortality by fifty eight percent at one year and all cause hospitalizations by thirty four percent including heart failure. Patients go through cardiac rehab are more prescription and nutrition compliant. I think I understand that one. And cardiac rehab reduces hospital readmissions by thirty three percent. So amazing stats and I wanted to have an expert just sort of comment on things.

Brittany Dixon, MD: Yes amazing and I can't emphasize that enough because there are very few medication interventions that have such substantial impact in terms of lowering mortality or reducing hospitalization. So all cause mortality lowering by 58 percent, I mean I can't think of many other things post you know, heart attack, post stroke, post heart failure admission that would be so effective. And then hospital remissions and hospitalizations are you know a huge concern for the patient as well as the health system in general. You know no one wants these patients including patients themselves to always have to go back into the hospital for the same type of symptoms so having this be able to reduce the need for that is huge and I think that's where a lot of the impact on quality of life comes in. And then in terms of being educated, you know if patients understand why they're doing certain things or like why they're taking medications, why they need to eat a certain way; they're more likely to to keep it up in the long run and so I think that's very helpful. We really underestimate the importance of patient education and I think many systems now recognize that and that's why they have dedicated heart failure educators, dedicated diabetes educators. Because we want patients to learn more and so that they're more motivated to fulfill their part of the contract and getting better in their care.

Host: Yeah knowledge is power for sure and we've talked here about heart attack and open heart surgery, but I'm guessing other types patients might benefit from rehab in general cardiac rehab whether that's heart valve repair or replacement, whatever it might be, so maybe you can go through that like who else would benefit from cardiac rehab?

Brittany Dixon, MD: The most common patient as we mentioned is someone who's post myocardial infarction. Myocardial infraction's a fancy term for heart attack so if you didn't have a heart attack but let's say you have gone into the hospital and had a s stent placed in your heart that still qualifies for cardiac rehab.

Host: Okay.

Brittany Dixon, MD: Heart failure, we've mentioned that we a million times. That qualifies for cardiac rehab, any type of cardiac surgery so that would include valve replacement or repair. That qualifies for cardiac rehab. And there's different kind of levels of cardiac rehab too, so even when patients complete their initial twelve weeks, they may still stay in the facility and do a different type of program that's maybe like a level up. You know its not just having a heart attack there many other patients who benefit from it.

Host: Right. Yeah I just wanna again I appreciate your time this is the second one we've done together it's been great speaking with you. Just wanna give you a chance here, yeah we're talking here now today about cardiac rehab so after an event, after a procedure, but you and what you do for a living and trying to help people and save lives; what would be your best advice when you think about how to avoid finding yourself having open heart surgery or having a heart attack? What's your best advice on how to avoid becoming a heart patient?

Brittany Dixon, MD: I always say the best treatment for heart disease is prevention and I really mean that. We certainly underestimate the importance of that. So first thing you need to do is know your numbers, so there are a of known risk factors for heart disease. Some we can control, some we can't control. Things that we can control are you know our blood pressure, our blood sugar, our cholesterol. You should have a good idea, I mean everyone should have a good idea of what those numbers are and that means following up regularly with your doctor and getting bloodwork done, having these vital signs checked. So knowing where you lay, that is very important because you could have you know diabetes that's uncontrolled for years and it may not cause any symptoms in a short term but long term that's doing damage. That's causing plaque buildup in your arteries. Also there are certain habits that you can do. You mentioned exercise. Certainly with cardiac rehab that's exercise a big goal. Um, also bad habits to avoid, so like not smoking or using any tobacco products.

Um, so these things are all important and it sounds really cliche, but thecardiac risk is something that we sometimes can optimize. Now, there's things that we can't. Family history, unfortunately you can't control who you are related to, but you can do everything you can to control these other things and you know it may sometimes genetics takes over you may still be diagnosed with heart disease but I guarantee you'll be that much better in terms of overall disease process and recovery if you are later diagnosed in life. So yeah definitely,following up regularly, knowing your numbers. Sometimes there are screening tests and that's a whole other podcast in itself.

Host: It sure is yeah.

Brittany Dixon, MD: So just the first step is knowledge and I think that's important.

Host: Perfect. Yeah as you say, we cannot outrun our family history and genetics but knowing our family history would be good and also knowing our numbers, controlling the things like behavior, lifestyle, smoking, all of those things. Great stuff again Doctor thank you so much. Thank you.  

Host: And to learn more about heart health, please visit franciscanhealth.org/heartcare. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.