Rehabilitation After Cardiac Arrest

What is rehabilitation? Who is it for? Who qualifies?

While the doctors run tests to try and understand the root cause and best treatment plan for your loved one’s cardiac arrest, they should spend that time in the hospital resting. The combination of new medications, reduced activity, general feeling of unwellness, and worries can lead to mental and physical fatigue. To help your loved one regain their range of motion, strength, and ability to safely do activities they could previously do, physical rehabilitation is needed. But true holistic recovery includes overcoming dependence on family and others for activities of daily living. This is best achieved by participation in rehabilitation activities.

Think of rehabilitation (“rehab”) as renewal and rebuilding.

Rehab is a resource to help loved ones return to their everyday activities through training and therapy. It is common to need rehab after an illness. Therapy evaluation begins in the hospital before discharge. If the therapists and physical medicine and rehab clinicians feel that your loved one would benefit from additional therapy, they should recommend continuing rehab after discharge. There are many types of rehab, and each type serves a specific goal.

Types of rehab

Unlike stroke or heart attack, there are no formal guidelines for referring survivors of cardiac arrest to rehab. The scientific community is actively working toward creating a care plan for survivors of cardiac arrest and understanding which type of rehab will lead to maximal recovery. Currently in the United States, the majority of survivors who are able to show independence in their basic activities of daily living (for example, walking, toileting, and eating) are sent home with no rehab services. Others are provided the following options for rehab after hospital discharge:

• • Acute inpatient rehab facility: To be eligible, your loved one should be able to participate in and tolerate active rehab for up to three hours a day.
  • Subacute inpatient rehab facility: This is also called a nursing home. Your loved one’s therapists have determined that they are not able to tolerate more than one hour a day of rehab. 
  • Home with in-home services: Sometimes, survivors are able to go home but have home health aides or visiting nurse specialists attend to some basic medical or physical needs for a few hours. They may or may not provide therapy.
  • Home with outpatient rehab, like physical therapy (PT), occupational therapy (OT), and/or speech therapy: This is very common for survivors who can walk and eat and are very close to baseline but have specific areas that need therapy. These sessions can be up to an hour a day for 2-3 days a week. The total duration of therapy is based on what your loved one’s insurance allows. Outpatient clinics offer these therapy services by appointment outside of the hospital setting. Your loved one would travel from home to the clinic at their appointment time, much like they would with a medical appointment.

What is cardiac rehab?

Your loved one experienced a sudden, life-altering event. Their doctors have spoken to them about the root cause of their cardiac arrest and have begun a course of treatment. Cardiac rehab is a specific, outpatient rehab option designed for people who experienced a cardiac event. Cardiac rehab is a specialized rehab and is different from neuro rehab, where the focus is on brain recovery and issues like memory, mental speed, and attention. Cardiac rehab focuses on heart health. Under the guidance and supervision of professionals, cardiac rehab empowers survivors with the information and confidence they need to manage their new heart needs.

Who is cardiac rehab for?

Cardiac rehab will help your loved one feel confident in their recovery and allow them to learn ways to lower their chances of another cardiac arrest. Cardiac rehab positively affects stress levels, heart and lung fitness, and future survival. Additionally, it might be a good transition for those fitted with an implanted cardioverter defibrillator (ICD) before returning home. To find out if your loved one qualifies for cardiac rehab, speak with their medical care team before hospital discharge.

What does cardiac rehab consist of?

Cardiac rehab includes three Es – endurance (physical), emotional, and educational components. 

• • Endurance: Under the supervision of trained healthcare professionals, your loved one will learn how to push their body in safe ways with personalized exercise plans. They will learn to create positive habits to encourage a more active lifestyle and help them return to their daily activities.
  • Emotional: Stress has physical and mental effects, and it can hurt our heart over time. Through counseling, your loved one can improve their mental health and learn ways to manage stress.
  • Educational: Learn more about your loved one’s heart needs and health conditions, how to eat healthy, and how to manage new medications.

Does everyone who experiences cardiac arrest attend cardiac rehab?

No. Unfortunately, not everyone is told about cardiac rehab. As a family member now aware, you and your loved one can have a conversation with the doctor to see if it’s a good fit. The cardiac rehab programs have different locations, durations, insurance coverage, etc. All of them have the same goal of empowering your loved one, reducing their risk of another cardiac arrest, and helping them improve their quality of life after their cardiac arrest.

Types of therapies in rehab

Regardless of inpatient or outpatient rehab, the therapies provided are the same. Some types of rehab therapies are:

• • Physical therapy: Restores movement, strength, and balance through personalized exercises
  • Occupational therapy: Restores motor skills to help the survivor with their everyday activities 
  • Speech and language therapy: Improves swallowing, mouth and tongue movement, and talking difficulties
  • Cognitive rehab: Re-teaches or strengthens cognitive skills affected by illness, like memory, decision-making, and logical thinking

What are the benefits?

Rehab helps survivors overcome limitations that are preventing them from completing everyday tasks without fear or pain. Imagine reaching for the dish at the top of your cabinet and feeling a pulling on your chest. Or imagine having an ICD recently placed and not knowing if it’s safe to reach that high. Those who participate in rehab might feel more confident and safe about returning home, because they are now armed with more knowledge about the changes in their body, warning signs to look out for, and ways to integrate positive health behaviors into their everyday routine to reduce the likelihood of experiencing another cardiac event. It can also help those who were active athletes safely return to working out.

What does your loved one need in the early phases of recovery?

Willingness and patience with themself. Depending on how deconditioned your loved one’s body is after the cardiac arrest and their subsequent hospitalization, the amount of therapy they need can vary. It can be challenging to accept the fact that their body may feel weaker and more frail. It can also be frustrating to feel uncertain of what they can or should do moving forward. The most important thing your loved one needs when engaging in any therapy is patience with themself. They must always listen to their body and understand their limitations. Instead of comparing themself to where they were before they experienced a cardiac arrest, your loved one should try to find a way to set small, attainable goals and celebrate each bit of progress they make. It may take some time, but recovery is possible!

Where or when should your loved one think about rehab?

Rehab after cardiac arrest begins in the hospital but does not end at hospital discharge. The medical team might recommend additional therapy in an inpatient or outpatient setting to ensure your loved one continues to work towards independence and can return home safely.

How do you know if your loved one qualifies?

Your loved one might have already met with, say, a physical therapist or occupational therapist in the hospital. Based on those conversations, recommendations will be made about continuing therapies after discharge and which rehab option might be best for your loved one. Those professional recommendations are shared with the medical team and then presented to your loved one for discussion as part of their treatment plan. Your loved one and family members will always have the final say. Families can visit the places suggested by the case manager or social worker before deciding on the places based on the best fit for your loved one.

Sources

Cardiac Arrest FAQ: https://www.heart.org/en/health-topics/cardiac-rehab/cardiac-rehab-faq 

How Cardiac Rehabilitation Can Help Heal Your Heart: https://www.cdc.gov/heartdisease/cardiac_rehab.htm 

Integration of Neurologic & Cardiac Rehabilitation:  https://pubmed.ncbi.nlm.nih.gov/28147424/

Thank you to our contributors

Danielle Rojas & Katrysha Gellis