Rehabilitation After Cardiac Arrest

What is rehabilitation? Is it for me? Do I qualify?

While the doctors run tests to try and understand the root cause and best treatment plan for your cardiac arrest, you 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 you regain your range of motion, strength, and ability to safely do activities you 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.

When you think of rehabilitation (“rehab”), think of renewal and rebuilding.

Rehab is a resource to help you return to your 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 you 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, you 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 therapists have determined that you are not able to tolerate more than one hour a day of rehab. 
  • Home with in-home services” Sometimes, you 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 insurance allows. Outpatient clinics offer these therapy services by appointment outside of the hospital setting. You would travel from home to the clinic at your appointment time, much like you would with a medical appointment.

What is cardiac rehab?

You experienced a sudden, life-altering event. Your doctors have spoken to you about the root cause of your 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 your heart health. Under the guidance and supervision of professionals, cardiac rehab empowers you with the information and confidence you need to manage your new heart needs.

Is cardiac rehab for me?

Cardiac rehab will help you feel confident in your recovery and learn ways to lower your 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 you qualify for cardiac rehab, speak with your medical care team before hospital discharge.

What does cardiac rehab consist of?

Cardiac rehab includes three E’s – endurance (physical), emotional, and educational components. 

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

Does everyone who experiences cardiac arrest attend cardiac rehab?

No. Unfortunately, not everyone is told about cardiac rehab. Since you now know, you can have a conversation with your doctor to see if it’s a good fit for you. The cardiac rehab programs have different locations, durations, insurance coverage, etc. All of them have the same goal of empowering you, reducing your risk of another cardiac arrest, and helping you improve your quality of life after your 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 you with your 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 you overcome limitations that are preventing you 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 do you need in the early phases of recovery?

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

Where or when do you get to think about rehab?

Rehab after cardiac arrest begins in the hospital but does not end at hospital discharge. Your medical team might recommend additional therapy in an inpatient or outpatient setting to ensure you continue to work towards independence and return home safely.

How do you know if you qualify?

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

Thank you to our contributors

Danielle Rojas & Katrysha Gellis