Cardiac Rehabilitation in India: Need of the Hour

Cardiovascular disease (CVD) is a major health problem accounting for one of the leading causes of death all over the. WHO in 2019, estimated that 17.9 million people died from CVD which is 32% of global deaths. Amongst these 75% deaths take place in low and middle income countries. India reported 272 deaths per 100,000 due to CVD in 2016. Cardiac Rehabilitation (CR) is a multidirectional approach for patients with heart disease which includes health education, advice on cardiovascular risk reduction, physical activity, and stress management. Studies have shown that cardiac rehabilitation reduces mortality, morbidity, unplanned hospital admission, improvement in quality of life with better exercise capacity and psychological well-being. CR is longterm comprehensive programs provided on outpatient departments or in rehab center designed to the needs of individual patient needs. The major goals are to help patient regain strength, prevent further deterioration maintaining a healthy lifestyle and improve well-being. Divided into 4 phases, the 1st phase begins while the patient is still in the hospital with the aim to get the patient discharged from the hospital. Phase 2 includes sub-acute outpatient care in which post discharge follow up is done and patient is empowered to become more independent. In phase 3 of CR, also known as intensive outpatient rehab, more independent exercises and selfmonitoring is introduced to the patient. The main goal of this phase is to help patient manage their own heart condition for a happier and healthier life. Phase 4 is the last of all which is about maintenance of the changes done during the previous 3 phases. Rarely physical activity during rehab may cause serious problems like muscle and bone injury, possibly arrhythmia. In that case CR is stopped immediately and patient is referred to the doctor for management. Despite of known benefits participation in CR programs is around 20-50%. As per International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) study in 2020 there is a need for more CR in India particularly in north. Collaboration with health care providers, home based care, endorsement by clinicians and use of internet and mobile phones can enhance participation of cardiac patients in CR. 

Author(s): Devagourou Anubha

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