Cardiac Rehabilitation and Wellness Center Celebrates its 1-Year Anniversary

Heart attacks and other forms of heart disease can be a wake-up call for many patients. But after being diagnosed with heart disease, how do they start making life changes to protect their heart health?

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Cardiac Rehab Team. Left to right: Dr. Anne Thorson, Crystal Zhou, Dr. Donald Grandis, Angela Fong, David Janke, Vanessa Valle, Michelle Murray

One of the most effective ways is through cardiac rehabilitation, a well-rounded program that provides exercise training, nutritional counseling, support and education. To make this resource available to more patients, the UCSF Division of Cardiology launched its own cardiac rehabilitation program in October 2019.

“For patients who have had a heart attack, cardiac bypass, valve surgery, heart transplant, or conditions like angina or peripheral artery disease, cardiac rehab is well-established to help them live longer, avoid hospitalization, and improve quality of life,” said cardiologist Donald Grandis, MD. He and Anne Thorson, MD, co-direct the UCSF Cardiac Rehabilitation Program, which is based in Millberry Union on the Parnassus campus.

“If they stick with the program, most people find it extremely rewarding,” said Dr. Grandis. “They learn habits that make their life better, and sometimes even make lifelong friends.” Program graduates are encouraged to continue their exercise routines at local gyms after completion.

UCSF’s program consists of three 90-minute sessions a week for 12 weeks, for a total of 36 sessions. Patients meet individually and in small groups with a multidisciplinary team that includes cardiologists, exercise physiologists, nutritionists, pharmacists and a psychiatrist. The program includes four elements:

Exercise training: Exercise physiologists develop a routine tailored to each patient’s goals and abilities. Patients work out for a portion of each visit, and staff monitor their heart rate and oxygen levels. The rehab facility has a variety of equipment, including treadmills, stationary bicycles, recumbent ellipticals, arm ergometers, and weights. This enables patients of all sizes and those with conditions such as arthritis or poor balance to exercise safely.

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Cardiac Rehab Team cont. Karen Berlin and Dr. Alexis Beatty

Nutrition: Dieticians teach patients how to improve their diet, distribute cookbooks with heart-healthy recipes, and show them food props that demonstrate appropriate serving sizes of different food groups. “Patients also learn from each other, and share recipes and restaurant tips,” said Dr. Grandis. “It’s like being part of a club.”

Behavioral health: “Many people are traumatized by their cardiac event, or could use help managing anxiety or depression,” said Dr. Grandis. A psychiatrist leads individual and group counseling sessions focused on topics like resilience, mindfulness, behavioral modification, stress reduction and smoking cessation.

Education: “For people with cardiac disease, we know that heart medications save lives,” said Dr. Grandis. “We have two wonderful pharmacists who help patients understand why they are taking these medications, how they work, and how to obtain them.” Patients also learn more about heart disease, and what they can and cannot do in this new chapter of their lives.

“One of the strengths of UCSF’s program is that we give equal importance to exercise, diet, behavioral modification and education,” said Dr. Grandis. “We really care about the whole person.”

In addition to offering patients excellent care, the program will also conduct research. One of the first investigations will be piloting the effectiveness of home-based cardiac rehabilitation. “It’s hard for some people to come here three days a week,” said Dr. Grandis. “We’re going to study whether some people are better off doing part or all of the program at home, with the help of devices like smartwatches and Fitbits. In this digital age, this could be a way that we could expand the program and help more people.”

Both Dr. Grandis and Dr. Thorson have directed cardiac rehabilitation programs at other medical centers, and have witnessed their transformative power. “I was an interventional cardiologist in Pittsburgh, and noticed how some patients came back year after year with recurrent heart problems, but others who were doing cardiac rehab did great,” said Dr. Grandis.

He recalled one of his first heart attack patients who quit smoking, lowered his cholesterol, and did cardiac rehab. Decades later, the patient continues to do well. “The research shows that cardiac rehab is one of the best ways to reduce the likelihood of having another heart attack and improving your chances of living free from heart problems,” he said.

Elizabeth Chur

To date, 110 patients have enrolled and 25 have already graduated. Patient satisfaction with the program has been very high.

“Cardiac rehab helps people overcome the anxiety that comes after a cardiac event. They leave cardiac rehab with a set of tools and the knowledge that they have the power and control to improve their fitness and overall health.  It is rewarding to watch them build their confidence and increase their endurance and strength,” says Michelle Murray, Registered Nurse with the Cardiac Rehab Center.

Feedback from patients has been that the program gives them structure and increases their stamina; they are exercising more regularly and maintaining a healthy diet. Patients also appreciate the positive, knowledgeable, and friendly staff.

In addition to offering patients excellent care, the program also conducts research. One of the first investigations will be piloting the effectiveness of home-based cardiac rehabilitation.

Due to the COVID-19 outbreak, the program was closed in mid-March but rapidly transitioned to a remote program to allow patients to continue therapy, even while sheltering in place. Now, patients continue to participate in cardiac rehabilitation, utilizing a tailored combination of both in-person and remote therapy. The future plans are to enhance the program through continued development of remote rehabilitation, participation in a newly formed consortium of cardiac rehabilitation from the other University of California Health Centers, and research projects design to expand cardiac rehabilitation to more patients and underserved communities.

For more information, view the September 16th, 2020 Grand Rounds Presentation: Cardiac Rehabilitation: Past, Present, and Future, presented by Dr. Alexis Beatty and Dr. Anne Thorson.

Click here to learn more about the Cardiac Rehabilitation Team.