(File Date: 2026-02-20 10:24:03) الدليل السعودي لبرامج إعادة التأهيل القلبي والو

Patient Assessment Patients should undergo early assessment and individualized screening before initiating physical activity or exercise. Referral documentation must include baseline demographic data, clinical diagnosis, relevant investigations, and treatment history to guide safe and effective rehabilitation planning. 2.2.5.1 Medical history A comprehensive assessment must be completed prior to initiating cardiac rehabilitation to ensure safety, tailor the care plan, and optimize outcomes. The evaluation should include the following components:  Cardiac History and Diagnostic Information o Review of prior cardiovascular procedures (e.g., angioplasty, stent placement, CABG, valve surgery, pacemaker, defibrillator) with confirmed diagnosis. o Echocardiogram findings: cardiac structure, size, pumping function, and left ventricular ejection fraction (LVEF). o Additional cardiac imaging and diagnostic test results as applicable. o Documentation of comorbidities: diabetes, hypertension, dyslipidemia, chronic kidney disease, obesity, COPD, and other pulmonary conditions. o Date of most recent influenza vaccination. o Identification of any educational or cognitive barriers that may affect participation.  Symptom Assessment Presence or history of cardiovascular symptoms including: o Chest pain, tightness, or angina. o Dyspnea or shortness of breath. o Cough or respiratory distress. o Musculoskeletal pain. o Pain in the neck, jaw, or throat. o Ascites or fluid retention. o Orthopnea. o Tachycardia. o Dizziness, syncope, or vertigo o Cyanosis. o Fatigue or fever. o Skin rashes. Medication Review o Current medication list. o Assessment of adherence and patient compliance. o Notation of any adverse effects experienced.  Hospitalization History o Date(s) of most recent hospital admission(s). o Length of hospital stay. o Reason for readmission.  Functional and Physical Assessment o Identification of physical or orthopedic limitations that may impact mobility or exercise participation.  Cardiovascular Risk Factor Screening Family history of cardiovascular conditions (e.g., myocardial infarction, stroke, hypertension, sudden cardiac death). Assessment of: o Blood cholesterol and triglyceride levels. o Blood pressure control. o Diabetes status. o Smoking status (current, former, never smoked. o Body mass index (BMI) for obesity screening. o Physical inactivity using validated tools (e.g., GPPAQ). o Presence of excessive psychological stress.  Previous Cardiac Rehabilitation Participation o History of prior CR program involvement (attendance, number of sessions completed, patient goal achievement). o Documentation of any adverse cardiovascular events during previous CR. o Reasons for non-completion, if applicable.  Additional Medical History o Review of other significant past or chronic medical conditions not previously listed. 2.2.5.2 Physical measures: Vital Signs: Blood pressure, heart rate, and rhythm. Cardiovascular and Pulmonary Examination: Includes observation, palpation, percussion, and auscultation. Oxygen Saturation (SpO₂): Particularly in patients with pulmonary hypertension, adult congenital heart disease (ACHD), or known lung pathology. Body Weight and Height. Body Mass Index (BMI). Waist Circumference. Cognitive Function: Assessed using the Cognitive Failures Questionnaire (CFQ). Quality of Life Assessment: Utilize validated tools such as the SF-36 Health Survey. 2.2.5.3 Medical investigations Electrocardiogram (ECG). Exercise Testing: ECG-based Exercise Tolerance Test (ETT) or Cardiopulmonary Exercise Testing (CPET). Echocardiography: Resting or stress echocardiogram, including Dobutamine Stress Echo (DSE) as indicated. Cardiac Imaging: Diagnostic coronary angiography, Cardiac MRI, or Cardiac CT as clinically appropriate. Cardiac Biomarkers: Troponin T/I, Creatine Kinase (CK), B-type Natriuretic Peptide (BNP). Laboratory Tests: o Complete Blood Count (CBC). o Serum electrolytes. o Renal and liver function tests. o Fasting blood glucose and glucose monitoring. o Lipid profile including LDL-C, HDL-C, and triglycerides. 2.2.5.4 Plan and intervention: Important objectives The following objectives should guide the development and implementation of individualized care plans during Phase II cardiac rehabilitation: Maintain comprehensive written documentation of the patient’s care plan for use by the cardiac rehabilitation team. Develop a personalized intervention plan aimed at reducing cardiovascular risk factors and managing persistent symptoms. Promote patient education to enhance long-term health outcomes and overall quality of life. Support medication adherence and initiate or adjust pharmacologic therapy as appropriate. Ensure patients are prescribed and maintained on evidence-based medications, as indicated, including: o Aspirin and/or clopidogrel. o Dual antiplatelet therapy. o Lipid-lowering agents. o Beta-blockers (especially post-myocardial infarction). o ACE inhibitors, ARBs, aldosterone antagonists. o Calcium channel blockers, anticoagulants, and diuretics. Perform routine assessment of post-procedural wound sites to monitor for infection or complications. Maintain ongoing communication with the referring physician or specialist when clinical updates, clarification, or changes in care are required.