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Cardiovascular disease (CVD), encompassing conditions like Congestive Heart Failure (CHF) and heart disease, significantly impacts daily life and requires specialized care strategies. Occupational Therapists (OTs) and Physical Therapists (PTs) play crucial roles in home health settings, focusing on the patient’s independence and quality of life for those managing these cardiovascular conditions.
Physical Therapists focus on cardiovascular health and physical endurance, ensuring the patient can complete daily activities without becoming short of breath. Specific exercises aim to strengthen patients’ physical capabilities, reducing heart strain, and reducing the risk of complications. Just like any muscle, the heart needs to be worked in the right way; doing too much or too little can be detrimental. With these exercises it proves to the patient that because they have been diagnosed with a “scary” or “life-long” disease they can still complete their activities of daily living (ADL). Continuing to build confidence in themselves slowly to ensure that they are able to return to the things they love to do and not have to live in fear or regret. Physical Therapists specialize in bringing quality to days, in conjunction to all other care providers bringing days to life.
Occupational Therapists complement this by helping patients navigate instrumental activities of daily living (IADL) with greater ease. They provide adaptive techniques and tools for safer, more independent living, ensuring patients can manage their daily tasks and live safely in their homes. They are crucial in building the patient’s confidence in not letting the disease affect who they are as a person. For example, putting shoes, socks, and clothes on without working too hard to tire the patient out before starting their day. Ensuring that the patient knows when to take breaks and offering guidance on home modifications to enhance accessibility and safety with tasks around the house.
Together, OTs and PTs offer a holistic approach to care, combining physical rehabilitation with practical daily living solutions. They are hands-on with the family and patient more than most other care providers, playing a key role in education about managing heart disease effectively at home.
The feedback from those who have experienced integrated care approaches in cardiac rehabilitation (CR) is highly positive. A study highlighted that patients perceived long-term benefits from their participation, which positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions within these programs were particularly beneficial, contributing to the long-term maintenance of heart-healthy behaviors and better overall outcomes. These insights underscore the value of a combined OT and PT regimen, not only in facilitating recovery but also in fostering a return to a fulfilling lifestyle.
In conclusion, the roles of OTs and PTs in home health settings are vital for improving the lives of those with CVD. Their combined expertise not only enhances physical health but also ensures a safer and more independent lifestyle for patients.
The best approach in treating any patient is to have an interdisciplinary team doing what they do best and encouraging referral to the correct provider in their time of need.
1. Moulson N, Bewick D, Selway T, Harris J, Suskin N, Oh P, Coutinho T. A qualitative study of patient’s perceptions of two cardiac rehabilitation models. Patient Educ Couns. 2015;98(6):768-774. doi:10.1016/j.pec.2015.03.002
2. Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ. 2015;351:h5000. doi:10.1136/bmj.h5000
Mathew Kovalchick DPT, OCS
By: Dr. Laura Mantine
Love is all around this month, especially on Valentine’s Day, when we take time to turn to those closest to us and say those three magical words. However, if you have a loved one who suffers from advanced cardiac disease, one of the best ways to show how much you care may not come in a sentimental card or a box filled with chocolates. Instead, it may come from calling hospice. Oftentimes, people don’t realize that hospice care is an option for people who suffer from advanced cardiac disease. Instead, these patients often spend their final days and months in and out of the hospital, receiving treatments that do little to improve the course of the disease. Hospice offers a supportive program of holistic care designed to help patients manage symptoms, forego emergency room visits and receive convenient, compassionate care right in their places of residence.
The estimated annual cost of heart disease is about $200 billion each year. Heart disease is the leading cause of death in the United States across all demographics. Heart disease accounts for 17.8% of hospice deaths, second only to cancer (30.1%). During hospice care, cardiac patients are monitored by a team of physicians and nurses, who administer medications and treatments to keep them as comfortable as possible. Social workers can access valuable community resources. Chaplains and counselors provide emotional and spiritual care for the patient and family. Volunteers can sit with patients, read to them or help them with light household chores, and allow caregivers to get some much-needed respite.
End-stage heart failure is often marked by an abrupt, dramatic decline, followed by recurring recovery and stability until sudden death. Patients are ideal candidates for goals-of-care conversations when they have severe refractory heart failure or extensive symptoms of cardiac insufficiency, have tried or cannot tolerate maximum medical management and are not candidates for curative therapies or surgical interventions. Hospice care addresses a wide range of symptoms, including shortness of breath, chest pain, weakness and functional decline. Eligibility for hospice may require documentation of progressive loss of functional capacity over years, progressive failure to respond to therapies and a desire to discontinue curative treatment. Patients should check with their physician to see whether they are eligible for hospice based on their history of congestive heart failure, arrhythmias or heart attacks. The physician may also consider any coexisting diseases like HIV, diabetes, respiratory illness or kidney disease when transitioning a patient to hospice care.
In addition to increasing a cardiac patient’s quality of life, hospice often increases the cardiac patient’s quantity of life as well. In a study reported in the March 2007 Journal of Pain and Symptom Management, congestive heart failure patients who chose hospice survived 81 days longer than those who did not. Even when modern-day technology or surgery can no longer offer hope, patients with late-stage cardiac disease need to know that help is always available. Hospice allows these patients to experience as much joy as possible in their remaining days while minimizing their discomfort and pain.
References:
Centers for Disease Control and Prevention, National Center for Health Statistics. (2016). Multiple Cause of Death 1999-2015 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e1–e458. DOI: 10.1161/CIR.0000000000000485.
National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures 2018 edition.
Ziaeian, B., & Fonarow, G. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in cardiovascular diseases, 58(4), 379–385. doi:10.1016/j.pcad.2015.09.004
Abode Hospice & Home Health supports that our patients have the right to determine their own goals of care during the final stages of their illness. We focus on comfort, support, quality of life, and education.