Cardiac Rehabilitation Research Center

  • Tue, 2017/11/28 - 13:57

 

Director: 

Masoume Sadeghi, MD

Professor of Cardiology

Deputy of Research, ICRI

Editor in Chief, ARYA Atherosclerosis Journal

Isfahan Cardiovascular Research Institute

A WHO Collaborating Center in EMR

 

Assistant Director: 
Zahra Teimouri, MD
Assistant Professor of Cardiology 

 

Research Director: 
Hamidreza Roohafza, MD
Associated Professor of Psychiatry 

 

History:
The epidemic of coronary heart disease in low/middle-income countries is staggering.  More than 80% of cardiovascular death occur in low to middle countries, although cardiac rehabilitation (CR) could represent an important approach to mitigate cardiovascular disease in these countries, it is still underused in these regions. In Iran CR services and its referral is low and strategic plan are needed. This unit is the first cardiac rehabilitation department in Iran and even in Middle East that was initially established to perform a series of researches about the effects of CR on CVD patients but now it changed to a research center with main goal of increasing quality of life in cardiac patient. This unit has different types of rehabilitation and secondary prevention including advanced, at home and simple types for cardiac patients who suffered Coronary heart disease, post CABG and post PCI. Also, this unit has long term comprehensive programs including medical evaluation, exercise prescription, cardiac risk factor modification, education and consultations. These programs are designed to limit the effects of cardiac illness and risk for sudden death or re infarction. Besides several training courses are organized by this unit for the persons of other universities of IRAN who are interested in setting up their own cardiac rehabilitation units. (For more information go to Training Achievement). This research center has a NGO from cardiac patient and their families named Heart Friend Association. We had community based program and integrated activity in primary health care. This center did studies with ICCPR named (CR Survey around the Globe). 

 

Date of Establishment:

1 Jun 1996

 

Institutions Groups:

Masoume Sadeghi, MD 

Professor of Cardiology

 

Hamidreza  Roohafza, MD

Associated Professor of Psychiatry

 

Sayed Mohammad Hashemi Jazi, MD

Professor of Cardiology

 

Sedighe Asgari, PhD

Professor of Pharmacognosy

 

Vahid Shaygannejad, MD

Professor of Neurology

  

Faculty Members

Full-time faculty:

Masoumeh Sadeghi, MD

Professor of Cardiology

 

Afshin Amirpour, MD

Assistant Professor of Interventional Cardiology

 

Reyhaneh Zavar, MD

Assistant Professor of Echocardiography

 

Zahra Teimouri, MD

Assistant Professor of Cardiology

 

Faezeh Tabesh, MD

Assistant Professor of Cardiology
 

Part-time faculty:

Kiyan Heshmat-ghahdarijani, MD
Assistant Professor of Cardiology

 

Awat Feizi, PhD
Professor of Biostatistics

 

Marzieh Tajmir Riahi, MD
Assistant Professor of Echocardiography

 

 

Staff (Faculty/Research & Technical assistants/):

 

Hossein Heidari, MD

 

Mohammad Mehdi Hadavi, MD

 

 

Administrative Staff:

 

Safoura Yazdekhasti, B.Sc

 

Mitra Naderi, B.Sc

 

Elham Azizi, M.Sc

 

Neda Dorostkar, M.Sc
 

 

Objectives:

1.    Provide an unparalleled clinical research environment.
2.    Enhance and develop the work of established clinical investigators in simple way of rehabilitation.
3.    Foster excellence in clinical research training for investigators.
4.    provide an infrastructure to attract external funding
5.    Conducting phase I and II rehabilitation units in specialty hospitals as an overhead plan of ministry of health.
6.    Offering training to other cities and if needed other countries.
7.    Adding cardiac rehabilitation unit in the curriculum of endocrinology, cardiac, surgery and rehabilitation assistance course.
8.    Finding strategy to increasing the adherence and decreasing drop out of patients in rehabilitation units.
9.    Collaborating with national and international communities for changing knowledge.
10.    Educative plan for PhD, Post-doctoral, observer ship and research assistance. 
11.    Education material (Book text, Pamphlet, App) for patients, their families and high risk groups.
12.    Conducting RCT, cohort, observational qualitative research studies on cardiac rehabilitation in different risk group, sex and various diseases.
13.    Coordinating tele-rehabilitation and community CR and implement it in PHC and Health centers.
14.    Conducting clinical trial studies in secondary prevention and rehabilitation.
15.    Conducting simple models of rehabilitation for lower cost and more adherence of patients.
16.    Design and implementation of intervention for capacity building in secondary prevention.
17.    Epigenetic study and personalized medicine response to cardiac rehabilitation of cardiac patients.
18.    Quality of life, return to work and psychology improvement in cardiac patients.
19.    Registry of cardiac rehabilitation patients and their long term follow up.
20.    Develops an association for all CR program in our country.

 

Experience/initiative

  • The first comprehensive supervised CR center was established in 1996 at Isfahan cardiovascular research center, several CR units in other parts of the country were sequentially established after passing courses in this unit. This unit hold up 25 short course with 45 universities for more than 180 academic persons.
  • Since one of the main barriers to participate in CR activities is financial constraint in most countries such as Iran, several sessions with insurance companies and Ministry of Health were held to solve the problem. At last after a lot of negotiations, in 2000 they (insurance companies) agreed to cover all or part of the CR costs. As a result, CR attendance rates gradually increased. Cardiac patients with their families formed NGO named heart friends association at 2000.
  • This unit with several activities change to CR research center as a part of cardiovascular research institute in 2010. The first international CR congress was hold by this Centre at 2014.The first CR instruction prepared with cooperation of this unit in MoHME.
  • Newer CR strategies, including hybrid CR and home-based CR were established in 2016.
  •  Online virtual groups created to communicate easily and free of charge in 2016.
  • We have different protocol for our patients, the core components of the protocols, are patient risk assessment, physical exercise training, dietary counselling, psychosocial advising and intervention, risk factor modification (lipid, smoking, blood pressure, blood glucose, weight, and diabetes mellitus.
  1. Comprehensive center based CR: individualized physical activity for different categories of heart disease (ACS, Valvular heart disease, heart failure patients,) for high to low risk patients under supervision of CR team will perform. The Focus is on empowering individualize-based performance. Cognitive behavioral therapies with supervision of psychiatrics, and heart monitoring based on risk assessment will be done. All patients will be visiting by cardiologist, psychiatric, dietitian and sport medicine specialist.
  2. Hybrid based: The patients risk assessment is done by cardiologist in the first visit, then attended to 3-5 sessions of supervised-CR and continue their rehab at home, patients will be follow by call phone.
  3. home CR: After risk assessment, low risk patients and moderate risk patients who are not interested to attend on supervised programs, will be invited to join to the comprehensive education program with their families, then performing CR at home with planned telephone and interview follow ups.
  • Stake holders are
    • User groups: coronary heart disease (ACS, CABG, PCI, stable angina), Valvular heart disease, heart failure and heart transplantation, cardiac devices, arrhythmias.
    • Health care providers: (cardiologist, sport medicine specialist, physiotherapist, psychiatrics, psychologist, social worker, nurse, dietician, health volunteers, administrator
    • Insurance companies
    • Academic and scientific organizations: (universities, hospitals, research centers)
    • Providers of rehabilitation equipment
    • Policy makers: government, MoHME

 

Who Makes Up the Cardiac Rehabilitation Team

  •  Cardiologists

  •  Sports medicine physician   

  •  Psychiatrist

  •  General physicians (GPs)

  •  Nurses 

  •  The occupational Therapist

  •  The dietician or nutritionist 

  •  Psychologist

 

Ongoing Studies

 

Completed Studies

 

Publications 

 

Services:

This unit has been established based on specific aims such as several evaluations like determining CVDs risk factors, the rate of exposure to these risk factors which have done in order to plan the preventions and treatment protocols. 

 

These Evaluations Include:

1. Completing demographic data form

2. Take the history physical examination of patient

3. Echocardiography

4. Prognostic exercise test

5. Risk stratification (R.S)

5. Psychological tests to determine agitation and depression of patient 

6. Lab tests to determine lipid profile, blood glucose, etc.

7. Completing some questionnaires such as daily diet, daily physical activity (IPAQ), quality of life (MACNEW).

 

The patients will be under supervision of physician, physiotherapist and nurse to exercise programs during 12-36 sessions, 3 sessions in the week, every session in about 90 min.

These programs would be planned according to the evaluated risk of patients and if it is necessary, cardiac monitoring will be done for them.

At the end of rehabilitation period, patients are evaluated for second time and compare with first results and with finally reports they would be referred to the physician or cardiac wards that they referred.

In addition training classes could be done for patients and their families as face-to-face or group classes through their exercise period.

 

Some of the training titles are as fallow:

1. What we should know about our heart

2. How much energy patients need and how to obtain it

3. Heart drugs and their side effects

4. Appropriate nutrition

5. How to encounter with daily stresses

6. Blood pressure in cardiac patients

7. Blood lipid in cardiac patients

8. Risk factors in CVD

9. Tobacco

10. Healthy heart in children

11. CPR

 

Center Equipment:

  •  Elliptical machines
  •  Stationary bikes (medical)
  •  Treadmills (medical)
  •  Arm ergometers
  •  Recumbent stationary bikes
  •  Weight machines
  •  blood pressure tracker
  • Telemetry cardiac monitoring
  •  CPR equipment’s and DC shock
  • Exercise test equipment’s
  •  Glucose Tracker
  •  Oxygen

 

Benefits:

Cardiac rehab offers many benefits. It can improve your ability to carry out activities of daily living, reduce your heart disease risk factors, improve your quality of life, improve your outlook and emotional stability, and increase your ability to manage your disease.

 

Education should achieve two key aims:

- To increase knowledge and understanding of risk factor reduction

- To restore confidence and foster a greater sense of perceived personal control

 

Cardiac rehabilitation education should be tailored to individuals and their needs and include:

  •  pathophysiology and symptoms
  •  physical activity, diet and smoking
  •  weight management
  •  other risk factors: blood pressure, lipids and glucose
  •  psychological/emotional self-management
  •  social factors and activities of daily living
  •  occupational/vocational factors
  •  sexual dysfunction
  •  pharmaceutical, surgical interventions and devices
  •  cardiopulmonary resuscitation
  •  additional information, as specified in other components

Cardiac Rehabilitation Indications

Nutritional Counseling

Obtain estimates of total daily caloric intake and dietary content of saturated fat, trans fat, cholesterol, sodium, and nutrients

 

Assess eating habits, including fruit and vegetable, whole grain, and fish consumption; number of meals and snacks; frequency of dining out; and alcohol consumption

Determine target areas for nutrition intervention as outlined in the core components of weight, hypertension, diabetes, as well as heart failure, kidney disease, and other comorbidities

 

Prescribe specific dietary modifications

Aiming to at least attain the saturated fat and cholesterol content limits of the Therapeutic Lifestyle Change diet. Individualize diet plan according to specific target areas as well as heart failure and other comorbidities. Recommendations should be sensitive and relevant to cultural preferences

 

Psychosocial Care

  • Reduce fear and anxiety
  • Assist with adjustment
  • Promote positive attitude
  • Facilitate behavior change
  • Identify need for further support

 

Management of Psychosocial and professional issues

Patients with heart disease are often confronted with psychological and social problems that can affect both morbidity and mortality. Depression, anxiety, and denial occur in up to 20% of patients following myocardial infarction. During cardiac rehabilitation follow-up, patients undergo a routine screening to identify anxiety, depression, substance abuse and familial or other social problems. The social workers and others professionals involved in the multidisciplinary team in cardiac rehabilitation centers provide patients with the information and the help they need to plan for their return to work and to a normal life.

Medical, psychological and social interventions tailored to individual problems are offered and have been shown to improve outcomes.

The INTERHEART Study quite clearly demonstrated that stress was the third most important risk factor for coronary events, following lipids and smoking, and accounts for approximately 30% of the populations attributable risk of acute MI .Psychosocial stress affect cardiovascular disease process through the increase in blood pressure, blood glucose, lipid levels and body weight. It also promotes the progression of atherosclerosis, inflammation and endothelial dysfunction.

Exercise training has been associated with reductions in stress and its related mortality.

Many cardiac rehabilitation Problem solving also ability stress management session to help patients identify, avoid and deal with stressful situations.

Cardiac rehabilitation is therefore an important therapeutic tool for distressed cardiac patients. Besides exercise training, many cardiac rehabilitation centers offer other stress reduction techniques training including meditation, relaxation breathing, yoga etc.

 

Steps: 

Assessment 

Occurs at first point of contact (diagnosis, exacerbation or risk factor recognition) by the health care practitioner. 

Followed by regular periodic reassessments carried out to determine consumer progress (includes the impact of the various social determinants of health). These range from structured follow-ups in primary care, to case management by specialist practitioners, depending on the level of need.

 

Education and self-management strategies to promote behavior change 

Provided by all members of the team, opportunistically at first point of contact and ongoing at multiple points to promote the benefits of CRSP and health literacy. Topics include: cardiovascular risk factor modification, symptom and heart disease management, the importance of medication adherence and regular medical assessment, and stepped role resumption. 

A management plan can be developed in partnership with the consumer/career, to record milestones and goals. Referrals to other services may be required

 

Exercise 

Group exercise, exercise instruction and/or advice are provided according to the consumer?s clinical features, documented risk, psychosocial needs, circumstances and logistics.

 

Psychosocial Support 

Promotes a deeper understanding of the challenges faced by the patient 

Helps to identify depressive and anxiety states that may require further review or intervention.

 

Medical Follow-up 

Usually carried out by the person?s general practitioner (GP), and, when appropriate, cardiologist or other physician. Includes review of biomedical markers (e.g. lipids, blood pressure), medication prescription and progress on all of the above.

 

Comprehensive Program

The comprehensive Cardiac Rehabilitation Program offers several phases of the program to serve your needs, including:

 Phase 1: Hospitalization. Evaluation, education and rehabilitation efforts begin while you're still in the hospital following a cardiac event.

 Phase 2: Early outpatient. In the immediate post hospitalization period, you'll begin attending classes and participating in a regular exercise program. Exercise specialists, registered nurses, doctors and others closely monitor you. Most major.

 Phase 3: Extended outpatient. This is a self-pay supervised exercise service that is designed for maintenance and ongoing progress of your heart health. Your vital signs are checked routinely. ECG monitoring isn't performed routinely in this phase unless your doctor determines it's necessary. Generally, people in this phase have graduated from phase two.

Most innovative

  • Affordable strategies such as home and hybrid form of CR.
  • Manage the financial problems with insurance companies.
  • Sending feedback to own physicians regarding changes in patient profiles during CR for more referral.
  • Active invitation of patients with coordination with their physicians.
  • Patient gathering in events such as world heart day with boots to be a role model for other patients, cooking exhibitions, walking program, and monthly last Friday flock to eat healthy breakfast with a teaching lecture.
  • Empowering Patients and their families with self-care initiative plans.
  • Multicenter educative program to expand CR accessibility and utility in other cities.
  • Integrating CR updates in the CME cardiology congress.
  • Developing CR-only women programs.
  •  Integration with cardiac group of university for one month visit of cardiology residents

 

Future Policies

1. Design and localization of cardiac rehabilitation program in Iran.

2. Research in palliative care in cardiology

3. Research in Social Determinants of Cardiovascular Diseases

4. Research In Mental-social wellbeing of cardiovascular disease

5. Develop policies for preventing heart disease and stroke at national, state, and local levels to assure effective public health action.

6. Define criteria and standards for population-wide health data sources. Expand these sources as needed to assure adequate long-term monitoring of population measures related to heart disease.

7. Encouragement with Training and specialists for refereeing CVD patients to all rehabilitation units.

8. A referral system put into operation by CCUs and cardiac wards with the supervision of related physicians for their high risk patients and relatives

9. Adding a one month cardiac rehabilitation course to cardiac residents? in the special training period.

10. Holding the international congress of rehabilitation.

11. Training PHD student

 

Address:

Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, 

Shahid Rahmani Alley, Moshtagh Sevom St.,

Isfahan, Iran

Postal Code:

8158388994

Tel: 

+98 31 36115208

+98 31 36115209

Fax: 

+98 31 36115209

Email:

crrc.mui@gmail.com