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Cardiac rehabilitation, which reduces the risk of another heart attack, does not only involve physical exercise. It is primarily knowledge that allows you to safely return to normal life and enjoy it for many years without fear of another heart attack – says Dr. Jadwiga Wolszakiewicz.
Agnieszka Fedorczyk, MedTvoiLokony: What is cardiac rehabilitation for?
Dr. Jadwiga Wolszakiewicz: Cardiac rehabilitation is comprehensive activities aimed at secondary prevention of heart diseases, treatment and improvement of the quality of life and functionality of patients, limitation of disease progression, and reduction of mortality resulting from cardiovascular diseases.
While probably every Pole has heard what a heart attack is, we still know too little about cardiac rehabilitation as a society.
Unfortunately yes. And yet the roots of cardiac rehabilitation go back to the 50s. Before that, yes, there were only a handful of pioneers who said that exercise was healing. However, in general, in patients after a heart attack or in cardiovascular diseases in general, any physical activity was a contraindication. This approach resulted in the patient remaining in bed after a heart attack for six months …
The consequence of this was long-term immobilization – significant motor disability and, in fact, the inability to return to normal functioning. Therefore, they began to wonder whether to introduce a program that would allow the patient to exercise safely, simply to navigate after a heart attack. And the principles of cardiological comprehensive rehabilitation were developed.
What was the effect of this?
The stay of patients after a heart attack in hospital wards has been significantly shortened. Thanks to the new rules, the patient left the hospital 7-10 days after the heart attack with appropriate recommendations for physical activity, which were to lead to further improvement of his physical capacity. Currently, the hospital stay after a heart attack has already shortened to 4-5 days for some patients.
In common opinion, cardiac rehabilitation is associated with physical activity, and it is much more …
Cardiac rehabilitation involves more than just physical training. Its aim is the broadly understood preparation of the patient for life after a heart attack and the consolidation of healthy lifestyle habits. In addition to regular physical activity, we teach the patient what to eat and why. The participation of a psychologist who explains the causes of the disease related to lifestyle is important in cardiac rehabilitation. The key is for the patient to understand what a heart attack is and what its consequences and complications may be. Why is it important to take medications regularly as recommended by your doctor and not stop taking them on your own, because it can be dangerous. We are preparing it for a new old life.
The first cardiac rehabilitation programs were created in Poland….
… In the 60s. It is worth noting that these were pioneering programs on a European scale. A decade later, we already had several cardiac rehabilitation departments in Poland, incl. in Inowrocław, Nałęczów and Konstancin.
How was its availability?
Cardiac rehabilitation was known, but not very popular. We knew that it was beneficial and every patient should be rehabilitated. However, the conviction of the cardiologists community about this method of treatment was not strong enough, as evidenced by the small number of centers existing at that time. Twenty years ago, when I started working as a cardiologist and specialist in the field of cardiac rehabilitation, many provinces did not have the possibility of rehabilitating cardiac patients at all. Many years of work of the medical community have led to the fact that the availability of cardiac rehabilitation has significantly increased over the last two decades – from 3% to 30%. up to XNUMX percent
In November last year, a program of Coordinated Specialist Care after myocardial infarction (KOS) was also introduced.
It is a pioneering program on a European and global scale, thanks to which every patient who is hospitalized after a heart attack can benefit from specialist care for a year. As part of this care, apart from regular visits to the cardiology clinic, cardiological rehabilitation and all the necessary procedures and activities that the patient requires after a heart attack are also included. If there is a need to implant a patient with a cardioverter or a pacemaker, it is ordered and implemented under the KOS program within an appropriate time frame, without waiting in the queue.
Does the patient have to stay in the hospital for the duration of such procedures?
Basically it is outpatient care. The department only performs revascularization, bypass surgery, and the implantation of stents to restore clogged vessels as a result of atherosclerosis.
What is the biggest advantage of the KOS program?
Access to a cardiologist, regular visits and the possibility of using rehabilitation and outpatient consultations. A patient after a heart attack should not wait too long after leaving the hospital for a consultation with a cardiologist, and as we know, the average waiting time, apart from the KOS program, is three months or longer depending on the region of Poland.
We know that so far few patients use the KOS program? What are the reasons for resigning from this benefit?
Different, but the most common reason is that not all hospitals implement this program. Often also a large distance from the center where rehabilitation can be performed. Women more often give up cardiac rehabilitation, explaining that they have children or grandchildren to look after and do not have time to travel to rehabilitation and cardiology consultations. Fortunately, the number of rehabilitation centers is growing, as well as social awareness that it is not enough to survive a heart attack, and that it is important not to suffer another one. It is worth noting that telemedicine is developing in our country, thanks to which the patient can be rehabilitated remotely, staying in his place of residence. Contact with the rehabilitation center is provided by special devices that monitor the patient’s condition remotely. Poland is the only country in Europe and the world where cardiac telerehabilitation is reimbursed by the state as part of the guaranteed services package.
Dr. Jadwiga Wolszakiewicz, chairwoman of the Cardiac Rehabilitation and Effort Physiology Section of the Polish Cardiac Society and the Chairwoman of the Organizing Committee of the XNUMXnd Symposium of Cardiac Rehabilitation and Physiology of the Polish Society of Cardiology, which ended in Jachranka.