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Cardiac Disease Management

Overview

The Cardiac Disease Management Program is designed to provide care and education to patients with heart disease. The program coordinates care for patients under the direction of their physician, and provides ongoing assessment, education, and treatment for a range of cardiac illnesses including coronary artery disease, atrial fibrillation, heart failure, and cardiomyopathy.

Components

  • Case management by trained Registered Nurses who will coordinate the care prescribed by the physician.
  • Assessment of the patient’s status through individualized visits by the home care Registered Nurse.
  • Evaluation and education by trained Physical and Occupational Therapists in home exercise programs, individualized to improve the patient’s strength and endurance.
  • Education about risk factors including high blood pressure, high cholesterol, smoking, obesity, stress, and diabetes.
  • In-depth instruction of the medications used to treat heart disease including ACE Inhibitors, Angiotensin II Receptor Blockers, beta blockers, calcium channel blockers, diuretics, nitrates, anticoagulants, and antiarrythmics.
  • Post-operative teaching for patients including Coronary Artery Bypass Graft (CABG), Automatic Implantable Cardioverter Defibrillator (AICD), and Permanent Pacemaker (PPM).
  • Education and management of patients at home with advanced technology equipment such as the Pleurx catheter and Life Vest.
  • Telehealth monitoring and evaluation of blood pressure, heart rate, oxygen level, weight, and temperature.
  • Education about the importance of exercise in managing heart disease including monitoring heart rate, pacing activities, and symptoms that indicate the patient should slow down or rest.
  • Teaching related to the dietary restrictions needed to manage cardiac disease including meal planning, label reading, and food choices.
  • Interdisciplinary team approach to assisting patients to cope with heart disease through the use of trained Medical Social Workers and Pastoral Care Chaplains.

Outcomes

Each patient will go through the Cardiac Disease Management Program differently based upon his/her disease process and individual needs. All indicators will be monitored to assess patient outcomes.

  • Patient’s ability to verbalize understanding of the disease process, medications, and dietary restrictions.
  • Patient’s compliance with daily home exercise program.
  • Measurement of patient’s vital signs, weight, and edema (swelling).
  • Patient’s compliance with risk reduction strategies such as smoking cessation and weight reduction.