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The Shortage of Cardiac Rehab Programs in Rural Oklahoma.

Cardiac rehabilitation is a medical service that allows patients who are recovering from acute coronary syndrome (ACS) and heart failure (HF) to regain physical stamina and take control of their heart health. Patients enrolled in cardiac rehab programs are supervised by registered nurses while they engage in physical activity. An interdisciplinary team of health professionals provides counseling to patients on lifestyle modifications and management of their medical condition. The medical and social support offered by cardiac rehab programs improves the patient's "quality and length of life" (American Heart Association, 2017). The outcomes demonstrated by participation in cardiac rehab is so positive that it is now recommended by the AHA that all eligible patients be referred for enrollment into a nearby cardiac rehabilitation program.

However, despite the evidence supporting the effectiveness of cardiac rehabilitation, only one in three post-ACS patients adhere to the recommendations to participate in cardiac rehabilitation (Doll, 2015). Several challenges exist that account for this statistic: there are very few cardiac rehab facilities that are within a convenient traveling distance. According to the Oklahoma Association of Cardiovascular and Pulmonary Rehabilitation (2017), the state has approximately 30 rehabilitation service facilities. Most are concentrated in the Tulsa and Oklahoma City metropolitan area. The lowest concentration of cardiac rehabilitation programs is in Western Oklahoma. Without a rehab facility in close proximity to home, patients struggle to find time to travel to and from the services that they are eligible for and would benefit from. Additional barriers to participation include the hours of operation of some programs and the cost that patients may incur to utilize services. These barriers make it difficult or impossible for some patients to participate in the services provided by cardiac rehab facilities.

It is critical that cardiac nurses in Oklahoma understand the challenges rural patients have in adhering to post-ACS recommendations so that we can help break down barriers, optimize compliance, and improve health outcomes. Nurses should screen patients for challenges they'll have in participating in post-ACS recommendations. At discharge, the nurse should include thorough education regarding prescription medications and discuss the importance of follow up care (Cardiac Care Network, 2013). When cardiac rehab is not accessible, the American Heart Association (2017) recommends referring the patient to a cardiologist for individualized exercise plans and offers an online support network for patients. Emphasis should be placed on measures that will ensure a smooth transition from the acute setting to the home setting such as ensuring that the patient does not have a delay in obtaining prescriptions and that the post-discharge plan is clear (Cardiac Care Network, 2013). The Cardiac Care Network also emphasizes that the use of technology, such as telemonitoring, helps to bridge access to cardiac rehabilitation for people in remote areas (2013).

Additionally, nurses can maximize adherence to post-ACS recommendations by helping patients to identify concerns and barriers. It may help to provide resources from the American Heart Association website regarding physical activity and wellness. Nurses can investigate the AHA website to learn more about cardiac rehab, frequent patient concerns, and available resources for patients.


American Heart Association. (2017). What is cardiac rehab? Retrieved August 11, 2017 from UCM 307049 Article.isp#.WY3LEumQvUk

Cardiac Care Network. (2013). Management of acute coronary syndromes: Best practice recommendations for remote communities. Retrieved March 26th, 2017 from public/uploadfiles/files/ACS management in remote communities FINAL Sept 2013.pdf

Doll, J., Hellkamp, A., Ho., P., Kontos, M. (2015). Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction. JAMA Intern Med. 175 (10):1700-1702. doi:10.1001/jamainternmed.2015.3819

Oklahoma Association for Cardiovascular and Pulmonary Rehabilitation. (2017). Rehab programs. Retrieved from

Toni Metheny, MS, RN, CNE and Juliana Bell, MS, RN

Metheny is affiliated with The University of Oklahoma Science of Nursing. Bell is affiliated with Southwestern Oklahoma State University School of Nursing. ONA membership status: Bell is a current member.

Caption: Figure 1: Locations of cardiac rehabilitation programs in Oklahoma. Adapted from "Rehab Programs" by Oklahoma Association for Cardiovascular and Pulmonary Rehabilitation, 2013, ( In the public domain. Large stars depict a higher concentration of programs.
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Author:Metheny, Toni; Bell, Juliana
Publication:Oklahoma Nurse
Geographic Code:1U7OK
Date:Mar 1, 2018
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