Naas General Hospital serves the people of Kildare and West Wicklow, population circa 185,000. This has been identified as one of the fastest-growing populations in Europe. Kildare also has the highest mortality rate from heart disease in Ireland. Patients living in this area are referred to the Cardiac Rehabilitation programme following a cardiac event. They may be referred by Naas hospital or other hospitals that they have attended.
Cardiac rehabilitation is the process by which patients with coronary heart disease are enabled to achieve their optimal physical, emotional, social, vocational and economic status (Jowlett and Thompson 1996). Patients are empowered to be involved in their own recovery by adopting the necessary lifestyle changes. Essentially the aim of cardiac rehabilitation is to improve the patients’ quality of life and, where possible, to slow, stop or reverse the progression of the underlying disease and therefore reduce the rates of re-infarction, graft closure and cardiac mortality.
Naas General Hospital offers a cardiac rehabilitation service to inpatients, outpatients and their families. Cardiac rehabilitation is a process which begins in Phase I on admission to the Coronary Care Unit and continues in the ward, right through to Phase II on discharge from hospital and to the Phase III exercise and education programme.
The cardiac rehabilitation team is multidisciplinary, directed by the cardiologist. It consists of a coordinator, cardiac nurse, physiotherapist, clinical nutritionist, pharmacist and health promotion nurse. Each health professional gives education talks pertaining to their own speciality.
Phase I Takes place in hospital. As soon as the patient’s condition has stabilised, the initial phase of cardiac rehabilitation is commenced in the Coronary Care Unit, starting with basic information around the cardiac event, reassurance, risk factor assessment and involvement and support of partner or family.
Phase II Is the convalescent stage following discharge from hospital. This is a crucial time for patients in terms of adjustment to change. It is seen as the time between discharge of the patient from the hospital after a cardiac event to their return to the outpatient Phase III exercise and education programme. We follow up patients, in Phase II through:
Phase III Takes place about 8–12 weeks following a cardiac event such as myocardial infarction, angioplasty, and coronary artery bypass surgery or valve replacement. It is sometimes regarded as purely ‘the exercise phase’. This is a misconception as education and lifestyle change sessions are also included in this phase.
The programme takes place over an eight-week period in the Cardiac Rehabilitation Department on level 3 Outpatients. It consists of one hour’s exercise three days a week, with one education session before or after the exercise class on one day a week. There is a warm-up of ten/fifteen minutes prior to the circuit. The aerobic phase lasts about thirty minutes and consists of a treadmill, cycle ergometer, hand crank, stepper, rowing machine and versa climber. To conclude the exercise session, there is a ten/fifteen-minute cool-down in order to taper off the exercise gradually.
The education talks include:
Cardiac rehabilitation is an important part of the recovery process for patients. We find that patients enjoy their time on the programme, self-esteem is improved, confidence is increased, questions are answered, and many new friends made.