Cardiovascular Rounds

Family members: A key ingredient for positive cardiac rehab outcomes

by Marissa Schwartz

When patients experience a myocardial infarction (MI), they need help getting back on their feet. Enter cardiac rehab, with its demonstrated efficacy to smooth recovery and improve outcomes. For all rehab programs, a critical first step is empowering patients to take charge of their own health. Yet new research suggests empowerment can be facilitated by involving the family as well.

Historically, cardiac rehab has proven to be an important strategy for restoring functioning and exercise capacity, preserving quality of life, and reducing mortality post-MI. But initial participation and long-term adherence rates for cardiac rehab are low, with studies estimating that roughly only 30% of eligible patients actually attend programs. There’s still room for improvement in access, compliance, and enrollment.

In response, cardiac rehab program directors have expanded their reach and doubled-down on patient engagement. Hybrid approaches to cardiac rehab combine in-hospital programs with home-based strategies. A new method takes the home-based rehab concept a step further by involving families in the process.

The Family-Centered Empowerment Model (FCEM) has been validated in various chronic disease states, and among post-CABG patients. New research by Vahedian-Azimi and colleagues, published in BMJ’s OpenHeart, randomized 70 post-MI patients to standard cardiac rehab or a hybrid program involving cardiac rehab and FECM.

At the beginning of hybrid care, patients identified a family member to support their recovery. The FCEM intervention then included 4 stages, largely comprised of group sessions, which patients and their designated family member(s) attended. Sessions focused on insight and awareness, expectations, acceptance, problem solving, and evaluating progress. Patients simultaneously participated in a traditional rehab program including daily exercise and education. The designated family member in FCEM was involved throughout the process: attending the same sessions, reviewing the same educational materials, and supervising exercise.

Results were promising: quality of life improved in the FCEM group throughout the intervention, and was higher in FCEM participants compared to standard cardiac rehab participants. Perceived stress and state anxiety also improved within the FCEM group over time and as compared to the control group.

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