Download Rehabilitation and Recovery - the Sudden Cardiac Arrest Association

th
7
The
Link:
Rehabilitation and
Recovery
Carrie St. Thomas, M.S., MBA
Disclaimer


Employee of Biotronik, USA
Previous employee of Medtronic, Inc.
Objectives:




What happens to a survivor post event?
How do we identify signs of emotional trauma,
and see signs of impending psychological
problems?
How can we provide help or intervene to manage
a survivor’s overall health?
What kind of support strategies are available?
Post Event

Adjustment period of 6-12 months
Involves development of coping skills
 Survivors and families incorporate lifestyle changes


Common behaviors and feelings
Denial of event/disease
 Returning to work/ADL concerns
 The need for emotional support
 Seeking information about disease/health

Fricchione, GL. Am Heart J 1989; 117:1411-1414
Physical Functioning





90% of SCA survivors were impaired in ADLs
20% had mobility problems
45% could not do vigorous activity
45% returned to sexual activity with reduced
frequency
The greater the physical impairments, the lower
the quality of life, more psychological distress,
more depression, and greater risk of CAD.
Sauve, MJ. Heart Lung. 1995; 24:133-144
Returning to Work



15-75% of people return to work post SCA
Those who do return retire in 6-12 months
Those who do return with success have strong
social networks at home
Most were married and had professional jobs
 High levels of education
 Better health history

Kalbfleisch, KR. Am J Cardiol. 1989; 64:199-202
Neurological Changes

Full neurologic recovery in SCA patients ranges from
12-70%


With the high probability of neurological impairment, most
do not receive neurological assessment pre-discharge
Potential cognitive impairments




May not be identified
Are minimized
Denied until work/family problems develop
Other neurological deficits include forgetfulness,
comprehension issues, and lack of problem solving
ability
Bainger, EM. Am J Cri Care. 1991; 4(1): 36-43
Psychological Adjustment


SCA survivors are more depressed, fearful, irritable, helpless,
unable to sleep, and feel less in control.
Commonly diagnosed psychiatric disorders seen in 50% of SCA
survivors include:




Adjustment disorder
Panic disorder
Major depression
Better psychological adjustment in survivors who are married
and have strong familial support
Morris, PL. Psychosomatics. 1991; 32:58-64
Negative Emotions

Negative emotions often follow SCA

Patient may feel:
Depression
 Anxiety
 Anger
 Fear
 Denial/Isolation

Depression

Obvious symptoms
 Depressed
mood
 Crying spells
 Loss of pleasure
 Struggle to control
mood
 Hopelessness
 Self blame
 Feelings of being
punished
 Withdrawal
 Thoughts of death

Subtle symptoms
 Sleep
problems
 Poor concentration or
memory
 Problems with
decision-making
 Vague pain complaints
 Slowed coordination
 Low sexual interest
 Change in appetite
 Change in weight
Conti, J.B., Cardiac Electrophysioogy Review Journal, 1999; Sears, S.F., Heart 2002
Anxiety

Nearly 40% of patients experience
symptoms of anxiety post SCA

This causes survivors to:
Avoid doing activities they like
 Have recurrent fears, often times of event
repeating
 Physiologic arousal (increased blood pressure,
faster heart rates at rest)

A Survivor’s Concerns:






Can you help me deal with this any better?
I know that my life was saved, but I still don’t
feel comfortable. I’m worried about a lot of
things.
I keep thinking about what will happen if
this occurs again.
As if life weren’t stressful enough, now I have to
deal with my heart condition.
I just want to be able to start driving again.
I’m too young to have this happen to me!
A Family’s Concerns:




Since he/she had a SCA, I’m afraid to get
him upset.
I miss our sex life, when can we be close
again?
I worry when he/she drives.
We don’t enjoy things like we used to.
Families Under Stress


Support persons, usually spouses, are at risk
for psychosocial problems
Top eight patient issues that affect support
persons:








Worry
Financial worries
Fear of physical exertion
Difficulty relaxing
Depression
Managing stress
Sexual issues
Returning to work
Intervention Programs

These programs for recovery should entail
A focus on the survivor and their family
 Be implemented early post event
 Address stress reduction options and methods for
coping
 Provide additional resources such as support groups
or online chat groups
 Provide strategies for adaptation to every day life

Psychological Interventions

Education and Support
Restore sense of control
 Encourage predictability
 Manage family emotional changes


Communication
Enhance communication among loved ones
 Sharing distress can lead to positive outcomes
 Openly face anxiety

Family Support



Strive for positive family adjustment
Use teamwork
Use coping mechanisms




Express feelings
Enjoy relationships
Encourage family to learn more about your
disease
Survivors and families may want to learn CPR
Positive Attitudes and Confidence
are Important
We want survivors to:





Recognize and control stress
Develop realistic and hopeful attitudes
Gain confidence in ability to accomplish
certain tasks
Evaluate the events of life, focusing on the
positive
Seek strength in others, and yourself
Health Care Providers



We know that patients need and expect help and
guidance from health care providers in order to
return to pre-event levels of functioning
Care providers should be aware of potential
impairment in cognitive abilities
Educate, share, and provide support

Know available support groups, SCAA chapters, etc
Questions to Answer
How do we increase health care provider
understanding of the challenges behind
surviving SCA?
 How do we support SCA rescuers?
 What other resources can be made
available to help survivors and families?
 What about an ICD?
