India has the dubious distinction of being the heart disease and diabetes capital of the world. Heart disease is the leading cause of death, and what's worse is that it strikes Indians, during the prime years of their life. Heart disease can be a life changing event, and many patients never fully recover from the blow, and end up being 'cardiac cripples'. It starts with a lack of mental confidence, leading to a drop in physical capability, which further reduces the confidence, and the vicious cycle continues. The good news is that heart disease is a largely preventable disease, and if appropriate lifestyle measures and medication are undertaken early enough, you may never need to undergo a cardiac interventional procedure.

At the Preventive Cardiology and Rehabilitation Department at Asian Heart Institute, we have a tailor made program to suit all categories:

Cardiac Rehabilitation program: for those who have already suffered a cardiac event, such as a heart attack, bypass surgery or angioplasty.

Secondary prevention program: for those who have been detected with heart diseases on routine tests, and want to avoid an interventional procedure, such as bypass surgery.

prevention program: for those who are at risk for heart disease, and want to avoid suffering, example those with a high BP, or cholesterol, or diabetes or a family history of heart disease.

Heart disease can be a life changing event as we discussed. But it can also be a positive life-changing event. If appropriate care is taken, most people not only recover from their event, but go on to improve their quality of life, to a higher level than before. After a heart event, post-care and rehabilitation is a vital part of the process. A structured cardiac rehabilitation program is crucial to get the patient on the path to recovery, and to prevent further illness.

The term cardiac rehabilitation, as defined by the World Health Organization (WHO) refers to coordinated, multifaceted interventions designed to optimize a cardiac patient's physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing risk of further disease.

The goals of cardiac rehabilitation are:

To help the person get back to his or her normal routine, as quickly as possible

To institute lifestyle changes and regular monitoring to reduce future risk of cardiac events

To improve the psychological well being of the cardiac patient.

Leading cardiology associations, such as the American Heart Association, have classified Cardiac Rehabilitation as a Class I recommendation, on par with other life saving measures, such as a daily aspirin dose. Extensive research shows that patients who underwent cardiac rehabilitation, showed a 20% reduction in total death and 26% in cardiac deaths when compared with those on usual medical care.

The outpatient program begins one to four weeks after the patient is discharged, and the sutures are removed (for those who have had surgery). The program is usually conducted three days a week, and lasts for three to six months depending on the patient's condition.

The patient exercises using portable heart monitoring equipment, known as telemetry. With the help of this special equipment, the ECG is continuously transmitted to the monitoring station wirelessly while the person is exercising. This ensures that the optimal amount of exercise is performed in the safest manner possible.

An individualized program of lifestyle modification, including nutrition, stress reduction and counseling is planned for the patient. Diet forms an important part of a healthy lifestyle and great emphasis is taken to ensure that the patient has a diet plan which is individualized to their needs.

Heart disease is caused by the presence of risk factors. During cardiac rehabilitation, great emphasis is placed on educating the patient on his/her risk factors and ways to reduce them. This helps attack the root of the problem. Many cardiac rehabilitation programs also include meditation and yoga, which greatly benefit patients, through stress reduction.

Heart disease can be a very traumatic event in a person's life. Several patients go through a short period of depression when they first get out of the hospital, wondering if they will ever be 'normal again', and be able to resume their activities. The support of family and doctors is extremely important, but often the best guidance comes from another person who has gone through the same experience. When in the cardiac rehabilitation program, patients interact with others who have had the same problems. This group support is very helpful to the patients and is an integral part of the program.

Those who have had:

Heart attack

Bypass surgery

Angioplasty

Angiography showing blockages

Heart failure

Heart valve replacement

Stable angina

While cardiac rehabilitation has several benefits for those with a heart disease, there is a group of patients who should not join, until their clinical condition is stable:

Unstable angina or angina at rest

Heart rhythm problems which have not been controlled with medications

Severe heart valve problems (in those who have not had the valve repaired)

Uncontrolled heart failure