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Rehabilitation Guideline after Myocardial Infarction - nurse labs myocardial infarction


Rehabilitation Guideline after Myocardial Infarction-nurse labs myocardial infarction

Rehabilitation Guideline after Myocardial
Infarction
Ulaanbaatar 2013
Rehabilitation guideline after Myocardial Infarction
APPEAL.....................................................................................................................................3
FOREWORD................................................................................................................................4
ABBREVIATION...........................................................................................................................5
PREFACE....................................................................................................................................5
KEY RECOMMENDATIONS..........................................................................................................7
A. INTRODUCTION
A.1. Definition of rehabilitation post myocardial infarction
A.2. International classification of diseases \ICD-10\
A.3. Guideline users
A.4. The aims of the guideline
A.5. Date of guideline development
A.6. Date of next revision
A.7. Guideline development group
A.8. Definitions and terminology used in guideline
A.9. Epidemiology
B. MANAGEMENT ALGORITHM
C. EVALUATION AND MANAGEMENT
C.1. Organization of Rehabilitation Services
C.2. Management and Secondary Prevention Strategies
C.2.1. Hospital Care Post Myocardial infarction - Phase 1
C.2.2 Immediate Post Discharge - Phase 2
C.2.3. Intermediate Outpatients - Phase 3
C.2.4. Long-term Maintenance - Phase 4
C.3. Education and patient information: Provision of Information
C.4. Secondary Prevention
C.5. Exercise Prescription
C.6. Safety: Adequate emergency response
C.7 Roles of the Multidisciplinary Team
ANNEXES
ANNEX 1. Basic concepts
ANNEX 2. Assessment and exercise testing
ANNEX 3. Protocols of exercise testing
ANNEX 4. Example of Detailed protocol for Cardiac Rehabilitation: Phase 1-4.
ANNEX 5. MET Values
ANNEX 6. Myocardial Infarction assessment form - Phase 1
ANNEX 7. Phase 1 exercise programme
ANNEX 8. Myocardial Infarction Assessment form - Phase 2-3
ANNEX 9. Example of home exercise programme
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Rehabilitation guideline after Myocardial Infarction
PREFACE
This guideline is primarily concerned with rehabilitation following myocardial infarction (MI) or coronary
revascularization, but also addresses the rehabilitation needs of patients with angina or heart failure.
This guideline was created by MOH and health project of MCC, WHO and professional committee of
rehabilitation of MOH, Mongolian society of physical & rehabilitation medicine, Mongolian Physical Therapy
Association, University of Health Sciences Mongolia (HSUM), the Shastin and State hospital. The guideline
reviewed by the Ministry of Social Welfare, the National Rehabilitation Centre, AIFO, Aimag- and Soum-level
representative hospitals.
This guideline includes clinical rehabilitation, prevention and management of the complications and community
based rehabilitation services.
The overall purpose of this guideline is to provide recommendations and evidence of the current international
evidence and best practise, which can guide the development of local protocols depending on the local
situation, in order to ensure a standard service of cardiac rehabilitation management.
This clinical guideline was primarily produced on the basis of the Best Practice Guidelines for Cardiac
Rehabilitation and Secondary Prevention by the National Heart Foundation (Australia, 1999), West Midlands
Cardiac Rehabilitation Standards (UK, 2010), The National Institute for Health and Clinical Excellence Clinical
Guideline MI: Secondary Prevention (UK, 2007), ACSM's Guidelines for Exercise Testing and Prescription
(US, 2008), The British Association for Cardiac Rehabilitation Guidelines (UK, 2003), The British Association
for Cardiovascular Prevention and Rehabilitation standards and core components for cardiovascular disease
prevention (UK, 2012).
This guideline states the recommendations for Cardiac Rehabilitation post myocardial infarction based on the
international current body of evidence and the recommended best practice based on clinical experience and
expert opinion.
It is recommended that local protocols are developed to standardize the management possible at the local
level (in terms of local human resources, patient management, referral network, where/how assistive and
adaptive devices can be purchased/made). - As developments within staff capacity, organization of
rehabilitation and equipment occur, the protocols should be reviewed and updated at regular intervals (ex.
annually).
The Annex within this guideline includes the basic concepts of exercise prescription, detailed information on
cardiac rehabilitation, examples of multidisciplinary assessment forms, discharge form and rehabilitation
terminology. Furthermore the Annex includes a checklist guideline that can support the implementation of the
national guideline and local protocols by guiding the healthcare professional through the patient management
from admission to discharge to the community.
KEY RECOMMENDATIONS
A number of key priority recommendations have been identified for implementation and these are listed below.
Discharge Planning
After an acute myocardial infarction (MI), confirmation of the diagnosis of acute MI and results of
investigations, future management plans and advice on secondary prevention should be part of
every discharge summary.
Physical Activity
Patients should be advised to undertake regular physical activity sufficient to increase exercise
capacity. Patients should be advised to be physically active for 20-30 minutes a day to the point of
slight breathlessness. Patients who are not achieving this should be advised to increase their
activity in a gradual, step-by-step way, aiming to increase their exercise capacity. They should start
at a level that is comfortable, and increase the duration and intensity of activity as they gain fitness.
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What are the 5 types of myocardial infarction?Type 2 MIType 1 MI (NSTEMI)Demand ischemia onlyUnstable angina onlyOther, please specify:None of the above / Not applicable

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