CARDIAC REHABILITATION FOR CORONARY ARTERY DISEASE PATIENTS – A LITERATURE REVIEW

Mubashshirah Firdaus Ansari, Nabam Mania, Shivpriya Sharma

Department of Physiotherapy, Sharda University, Greater Noida 201306, India.

Review Article

SALT Journal of Scientific Research in Healthcare, Volume 3, Issue 1, Page 01-10, Published on 08th Feb 2023, https://doi.org/10.56735/saltjsrh.ms2303010110

ABSTRACT  

Background and purpose: This literature review objective is to appraise the outcome of Cardiac Rehabilitation for (CAD) patients. Methods: This literature review constitutes the articles which were published in 2017-2022. The evidence search was performed on Google Scholar, PubMed database and Web of science. Results: According to 34 studies incorporated in our literature review shows that cardiac rehabilitation has led to enhancing the well-being of patients suffering from (CAD). We performed a literature review of different articles, including seven studies that were randomised control trials and seven studies that were systematic reviews, and three studies that were meta-analyses providing evidence on the benefits of cardiac rehabilitation and its recent advances in (CAD) patients. Discussion: This literature review, according to selective studies, demonstrates that routine exercise habits act as a precautionary regimen in patients suffering from (CAD). It has led to enhancement in cardiovascular strength and decreasing fatness in a healthy population. Exercise Based (CR) has also shown remarkable outcomes in enhancing the well-being of patients suffering from (CAD).

Keywords: Coronary artery disease, cardiac rehabilitation, home-based cardiac telerehabilitation, exercise-based cardiac rehabilitation.

INTRODUCTION

Coronary Artery Disease (CAD) is an inflammatory disease which occurs due to the formation of atherosclerotic plaque, and the deposition of lipids leads to blockage of the coronary artery, which causes ischemia and decreases the oxygen to the myocardium. An abnormal sequence such as angina, myocardial infarction, arrhythmias, heart failure and at last sudden cardiac arrest is common in CAD.[1] According to the global burden of diseases, widespread coronary artery disease all over the world has 154 million overall diseases related to cardiovascular health.[2] One survey was held constituting the population of 24-64 years in India which shows that 9.7% were people belonging to urban areas and 2.7% were people belonging to rural areas having coronary artery disease.[3] The complication of pharmacological and surgical treatment is higher in these patients; thus, alternative treatment, such as cardiac rehabilitation, can introduce in the treatment protocol.

According to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), “cardiac rehabilitation (CR) is defined as a comprehensive and coordinated long-term plan, including medical evaluation, exercise prescriptions, interventions for cardiac risk factors, health education, counselling, behavioural interventions, and so on’.[4]AACVPR divides cardiac rehabilitation into 4 phases: Phase 1- Inpatient programme – It takes a time period from 1-14 days. It focuses on advice-giving to the patients by lowering the predisposing factors and drug tolerance and by creating awareness through the engagement of family and patient to restart the activity of daily living.[5] Phase 2 – Sub-Acute-It starts from the eighth day to 6 weeks prior to the outpatient phase. The exercise and making the patient independent is educated to the patient, which comprises of checking the vitals, regulation of clinical manifestations and VO2 max with the help of a workmate. Phase 3- Outpatient based programme or hospital-based programme – It takes a time period from 6 weeks to 12 weeks, and the patient can visit two times a week while it also fulfils the need of larger patients by providing the facilities through domiciliary care, advanced technology like mobiles, digital services and electronic services. Phase 4 Maintenance phase or Community-based programme: In the maintenance phase, the workout performed by the patient can be one time in a week. The patients are made capable of self-inspection while making as a daily routine in their life. It plays a very crucial role in enhancing cardiorespiratory fitness, haemodynamic and muscle physiology. So, the objective of the literature review is to appraise the outcome of CR for CAD patients.[6]

METHODS

Search Strategy

In this literature review, we performed a literature review of different articles, including seven studies that were randomised control trials and seven studies that were systematic reviews and three studies that were meta-analysis providing evidence on the benefits of cardiac rehabilitation and its recent advances in CAD patients. The articles were looked out from Google Scholar and PubMed. Moreover, Scopus indexing was also checked.

Table 1: Recent articles showing the effect of Cardiac rehabilitation for coronary artery disease
 Table 2: Recent articles showing the effect of Postoperative cardiac rehabilitation in coronary artery disease
 Table 2: Recent articles showing the effect of Postoperative cardiac rehabilitation in coronary artery disease
Table 3: Recent advances in medical health related to coronary artery disease
Nanotechnology, Biodegradable Stents, Home Based Tele rehabilitation, Tissue Engineering and Behavioural Medicine Intervention in Physiotherapy have shown remarkable effects on CAD patients. 
DISCUSSION

Recent studies, according to “American Heart Association” denotes that Exercise Based Cardiac Rehabilitation which comprises Aerobic and Resistance Based Exercise Training, decreases the rise in baseline arterial blood pressure and action of sympathetic nerves to sudden exertion in patients suffering from CAD. Exercise Based CR has shown remarkable outcomes on autonomic function in addition to enhanced baroreflex control on maintaining sympathetic neural control in patients suffering from CAD.[10] The existing reviews, according to “The Journal of Cardiopulmonary Rehabilitation and Prevention”, depicts that remarkable enhancement in Cardiopulmonary Exercise Testing variables in relation to cardiovascular, endothelial, metabolic and autonomic systems was seen in patients suffering from CAD and those who were enrolled for Exercise-Based CR. The favourable outcomes have resulted in enhanced activity of the heart and cardiorespiratory fitness in patients suffering from CAD.[8] The multiple studies, according to “American Heart Association”, demonstrates that routine exercise habits act as a precautionary regimen in patients suffering from CAD. It has led to enhancement in Cardiovascular strength and decreasing fatness in a healthy population. Technology-Based telerehabilitation has resulted in beneficial outcomes in aerobic competency and longevity in patients suffering from CAD.[19] The narrative review, according to “Disability and Rehabilitation”, reveals that Rehabilitation Exercise performed daily has resulted in a remarkable decrease in the narrowing of coronary artery and late luminal loss post (PCI) in patients suffering from (CAD). Rehabilitation exercise started earlier after the (PCI) led to enhanced reserve volume, the functioning of cardiac health and perfusion in the coronary artery along with rapid return in power and decreased prevalence of CAD.[21] According to archives of medical research goal of this research is to judge the cardiac rehabilitation program effectiveness for CAD patients following CABG comprised of controlled medical centre-based physical therapy for four months. The acquired outcomes exhibit the enhancement of the patient’s physical activity in the CE test, along with cardiac productivity.[22] According to the journal of the “American Heart Association, “this study was done on patients with recent ischemic heart disease who were registered in Home-based cardiac rehabilitation and facility-based cardiac rehabilitation. The results were changed in the 6-minute walk distance along with the measure of the quality of life as well enhanced regularly between the HBCR patient.[12] According to “Journal Sports and Medicine”, this study was done on a meta-analysis of 10 RCTs consisting of 1274 patients. The results exhibit that the exercise and (PCI) together work in decreasing the possibility of cardiac death, MI, coronary angioplasty, angina pectoris and restenosis comparative to (PCI) only, along with there was a remarkable enhancement in left ventricular ejection fraction among individuals with exercise compared to those individuals without exercise. The level of hypersensitive C-reactive protein and inflammatory cytokines can decrease in patients suffering from coronary heart disease following PCI by exercise rehabilitation.[23] In the following study, according to “British Medical Journal Open Sport & Exercise Medicine” in mostly female patients suffering from CAD referred for a 24-week outpatient CR program, effects of AIT versus standard care MICE the main conclusion was that this prospective study design was unfeasible in this female CAD patient population, and difficulties encountered.[11] Around the world, according to the “World journal of clinical cases, “CR is underutilised. Inconsistent delivery, inadequate reimbursement, and other CR involvement hurdles in individuals are all issues, according to recent studies.[15] Our findings imply, according to “The International Journal of Behavioral Medicine”, that getting older is linked to improved general well-being, as well as mental health and a suitable atmosphere. Moreover, no effect on the association of cognition and well-being, as poorer perceived cognition was still related to poorer (HRQL).[18]

STUDY STRENGTHS AND LIMITATIONS

The literature review comprises the articles which were published from 2017 to 2022. The strength of the literature review is that it comprises the highest-graded articles like Randomised Control Trials and Systematic Reviews regarding the rehabilitation of patients suffering from (CAD). Moreover, the limitations of this article were that it had no effect on the link between perceived cognition and health-related quality of life. Further studies are still examining that Home Based Cardiac Telerehabilitation as a holistic approach in secondary precaution for CAD.

CONCLUSION

This literature review concluded that the effectiveness of multifaceted rehabilitation services has enhanced the well-being and accentuated follow-up protocol, ultimately leading to a decrease in the death rate of people suffering from CAD. Exercise Training based CR is significant in decreasing the susceptibility to CAD and in providing a longer life expectancy. Cardiopulmonary Exercise Testing (CPET) is used as a valuable and accepted tool in clinical assessment in providing information about medicinal adequacy in those patients suffering from CAD. It is a comprehensive test which has shown a significant increase in cardiopulmonary capacity in post-surgical patients. Outpatient CR has contributed to enhancing physical activity tolerance, decrease in high-risk sleep apnea in patients and greater viability is seen in patients. Further studies examine that Home Based Cardiac Telerehabilitation is a holistic approach in secondary precaution for CAD. Finally, CAD therapeutics’ future with CR appears to be very differently hopeful with the constant endeavour.

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ARTICLE TYPE: Review Article; ORCID ID: Open Researcher and Contributor Identifier (ORCID) ID of corresponding author: https://orcid.org/0000-0003-4668-3102 ; ETHICAL: Institutional ethical committee and prior patient consent obtained; ACKNOWLEDGEMENT: None; FINANCIAL DISCLOSURE: The authors declare that there was no financial aid received.; CONFLICT OF INTEREST: No conflict of interest associated with this research work.; AUTHORS CONTRIBUTION: M.F.A., N.M., and R.S., reviewed and wrote the article for publication.;  AUTHORS AFFILIATIONS:  Ms. Mubashshirah Firdaus Ansari, BPT Intern Student, Department of Physiotherapy, SAHS, Sharda University, Greater Noida 201306; Ms. Nabam Mania, BPT Intern Student, Department of Physiotherapy, SAHS, Sharda University, Greater Noida 201306; Ms. Shivpriya Sharma, Assistant Professor, Department of Physiotherapy, Sharda University, Greater Noida 201306, India.; CORRESPONDING AUTHOR EMAIL: shivpriya.sharma@ sharda.ac.in; ARTICLE CITATION: Ansari MF, Mania N & Sharma S. Cardiac rehabilitation for coronary artery disease patients- a literature review. SALT J Sci Res Healthc. 2023 February 08; 3(1): 01-10.

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© Mubashshirah Firdaus Ansari, Nabam Mania, Shivpriya Sharma 

Originally published in the SALT Journal of Scientific Research in Healthcare (https://saltjsrh.in/), 08.02.2023.

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