Preventive and Rehabilitative Cardiology

Programmes and Services

• Lifestyle Management
• Lipid Management
• Hypertension Management
• Stress Management
• Nutrition Counseling
• Smoking Cessation
• Post CABG Surgery Follow-up Care
• Post PTCA Follow-up Care
• Post Valve Surgery Follow-up Care
• Preventive Health Checkups
• Adult Vaccination Clinic
   

Objectives

• To promote healthy lifestyles amongst clients visiting Escorts Heart Institute and Research Centre, New Delhi in order to reduce their risk factor burden for heart and blood vessel disorders.
• To provide a platform for close surveillance of heart patients following adverse clinical events and early identification of recurrence of significant clinical problems.
• To identify asymptomatic heart disease, blood pressure, diabetes mellitus, substance abuse, depression, and other psychosocial problems.
• To identify and suggest remedial measures for the psychosocial problems of the clients enrolling in the programme.
   

Justification

Preventive and Rehabilitative Care is often neglected in most tertiary cardiac care centers of this part of the world where the focus lies on emergency care and interventional and surgical procedures. Nevertheless, it is an important area of care that addresses to the need for structured nutrition counseling, exercise prescription, smoking cessation, and weight, lipid, blood pressure, diabetes, and psychosocial risk factor management. Incorporating such care in conventional medical/surgical management is known to improve long-term successful outcomes.
 

Details The Team

A multidisciplinary and collaborative team of physicians, physiatrists (doctor in rehabilitation medicine), nutritionists, and counseling psychologists looks after the physical as well as emotional needs of the clients. A senior full-time clinical cardiologist supervises working of the team. The team works under the aegis of Department of Preventive and Rehabilitative Cardiology, Escorts Heart Institute and Centre Ltd., New Delhi, India. It was the first department of preventive cardiology established in India in 1993.
 

The Clients

The clients are invited to enroll after preventive health screening of apparently healthy adults and following comprehensive cardiac checkup after recovery from a major adverse cardiac event (MACE) or revascularization procedure.

Methodology

The cardiologist who takes over the responsibility of managing the medical problem(s) and identifies the risk factor status interviews each client. The client is given a detailed written prescription. The diagnosis clearly identifies three distinct problems, viz. cardiac problem(s), biological and lifestyle-related risk factors, and non-cardiac problems. The part dealing with medicinal treatment highlights the detailed directions for use including the duration of treatment in simple language. The prescription also incorporates the follow-up plan including further tests, treatments, and schedule for revisits.

This is followed by assessment of (i) the nutritional status, (ii) psychosocial status and the need for intervention, and (iii) aerobic capacity, muscular strength, flexibility, and back strength. These assessments are carried out by a nutritionist, a psychologist, and a physiatrist respectively using standardized tools, and based on their findings, an individualized lifestyle management is planned for the client.

The advice for lifestyle management is rendered by 1:1 counseling by the nutritionist, psychologist, and the physiatrist. The frequency of counseling is need based with 3-6 monthly re-assessment by supervising cardiologist.

Tools for Assessment

Risk factor and nutritional screening is carried out using a standardized questionnaire developed at Department of Preventive Cardiology, Escorts Heart Institute and Research Centre, Ltd. Psychosocial risk factor and substance abuse assessment is performed by using standardized questionnaires validated in our patient population. Assessment of aerobic capacity is done by a Treadmill or equivalent test and the physiatrist carries out assessment of muscular strength, flexibility, and back strength during clinical examination.

Tools for Client Education

• Besides 1:1 counseling, the clients are exposed to group counseling sessions and workshops. These workshops are conducted in-house as well as in the community at large as a part of corporate social responsibility of the organization.
• The team has produced a number of books and has been publishing a patient education journal. The books have been written in English and translated in Hindi. Some books have also been translated in several other regional languages of India.

Tools for Improving Compliance

Telephonic and postal reminders encourage regular visits by clients.

Implementation

Programme Assessment
Clients are encouraged to fill up a questionnaire to determine their satisfaction after every session.

A qualitative comparison of lifestyle management with standard physician-based advice related to diet, activity, and psychosocial issues had been carried out during initiation of the project to ascertain its additional utility.

Research and Other New Initiatives

A major research initiative has been taken in 2007-2008 with the aim to generate indigenous data on epidemiology of coronary heart disease and its risk factors. After completion of a Ph.D. thesis on Case-Control Study of Coronary Risk Factors in Middle Aged Urban Indian Males, the department has started a new study on the same lines amongst adult urban females of the age group 25-64 years.

Corporates Who Were Benefitted