Heart Health

Cardiac Rehab: Changes and Opportunities Ahead

Changes are coming on many fronts in cardiac rehab programs across the country. Those changes hold potential for improving nutrition care for patients and expanding job opportunities for RDs.

I recently returned from the annual meeting of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the fifth year in a row I’ve spoken to this multidisciplinary group of physicians, nurses, physical therapists, dietitians, and other cardiac rehab professionals. This time, I was sharing the podium with fellow Sports, Cardiovascular, and Wellness Nutrition (SCAN) Dietetic Practice Group colleague Ellen Aberegg, MA, RD, LD. Our topic: “Dietary Assessment: All Tools Are Not Created Equal.”

This presentation had its roots in a project that started when I realized that dietary assessment tools used in many cardiac rehab programs don’t actually match current cardiovascular nutrition recommendations. Often these tools overfocus on total and saturated fat consumption, missing the critical point that the health benefits of reducing saturated fat depend on what replaces it. When used as screeners to identify patients most in need of intervention by a dietitian, these tools can miss people who have cut saturated fat (perhaps as a new step in the wake of their cardiac event) without achieving the overall healthful eating pattern that puts vegetables, fruits, whole grains, and legumes at the heart of the plate, limiting added sugars and refined grains.

A group of nine SCAN cardiac-focused dietitians worked together on this project. We established criteria for optimal dietary assessment tools for cardiac rehab use, and then evaluated the 22 tools we identified. When Ellen and I presented the conclusions of our working group to AACVPR leadership a year ago, they made a request that took our project to a new level.

Changes Afoot

Dietary assessment will take on added importance with changes in cardiac rehab that lie ahead. New federal pilot projects, with “bundled” financial payments to hospitals for certain cardiac diagnoses, and cardiac rehab incentives in some places, are expected to increase cardiac rehab participation.

Meanwhile, growing participation in AACVPR certification and registry of cardiac rehab programs will promote tracking dietary change, patient outcomes, and program performance. Hopefully, this will show a difference with meaningful dietitian involvement, supporting the need for greater help for cardiac rehab patients.

At AACVPR’s conference this year, I discussed factors beyond matching current nutrition recommendations that are necessary for expanded goals of dietary assessment in cardiac rehab. For example, validation studies showing an acceptable level of measurement error, score ranges wide enough to demonstrate change achievable in a 12-week cardiac rehab program, and that fit within practical constraints of cardiac rehab settings are important. Ellen and I presented conclusions based on review of an expanded group of 25 tools.

For AACVPR program certification, at least one assessment tool in each category must be free of charge in the public domain. A free tool that received top evaluations in our original review by SCAN RDs is the Dietary Risk Assessment (DRA). The version we initially evaluated, known as A New Leaf, was originally recommended by Judy Hinderliter, MPH, RDN, LDN, CPT, who noted in a previous Today’s Dietitian article that she also values the educational material that accompanies the tool. In our recent efforts, Ellen discovered a version of the DRA that reflects principles of the Mediterranean diet for the Heart Healthy Lenoir project. Ellen and I think this tool holds great potential, too.

We are now pulling together a final review to support AACVPR’s goal of instituting new tools in 2017. Meanwhile, if you’re considering how you might join or expand involvement in your local cardiac rehab programs, check out SCAN’s webinar for some great information.

karen-collins— Karen Collins, MS, RDN, CDN, FAND, currently serves as chair of the Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. She’s also nutrition advisor to the American Institute for Cancer Research. As a consultant, Karen focuses on nutrition in the intersection of cancer prevention and heart and metabolic health. Visit Karen’s blog Smart Bytes® at http://www.karencollinsnutrition.com/smartbytes/

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