Article

A recent policy change from the Centers for Medicare and Medicaid
Services includes coverage of cardiac rehabilitation (CR) for patients with
chronic heart failure (CHF) with reduced ejection fraction.
This article provides
a framework by which CR programs can incorporate disease-specific services for
patients with CHF who participate in CR. DISCUSSION: Cardiac rehabilitation
should include self-care counseling that targets improved education and skill
development (eg, medication compliance, monitoring/management of body weight).
Various tools are available for assessing exercise tolerance (eg, stress test
with gas exchange and 6-minute walk), health-related quality of life, and other
outcome-related parameters. Exercise should be prescribed in a manner that
progressively increases intensity, duration, and frequency, to a volume of
exercise equivalent to 3 to 7 metabolic equivalent task (MET)-hr per week. The
benefits of exercise training are limited by patient adherence; therefore, CR
providers need to identify the adherence challenges unique to each patient and
address each accordingly. To optimize the referral of patients with CHF to CR,
program staff should develop strategies to raise both health care provider and
patient awareness about the benefits of CR, as well as work collaboratively to
set up system-based approaches to CR referral. CONCLUSIONS: The referral of
patients with CHF to CR will increase in 2014 and beyond, due partly to a policy
change from the Centers for Medicare and Medicaid Services that allows coverage
for CR. These patients should be integrated into existing programs, with the
intent of providing both standard CR services and CHF-specific education and
disease management activities that target improved outcomes.

Langue : ANGLAIS

Tiré à part : OUI