How can I effectively monitor and support patients with comorbidities during their cardiac rehabilitation journey?

To effectively monitor and support patients with comorbidities during their cardiac rehabilitation management, it is essential to tailor the rehabilitation programme to their specific clinical conditions and needs. Patients with cardiac or other clinical conditions that may worsen during exercise should have these conditions treated if possible before starting the exercise component, and the exercise programme may need adaptation by a qualified healthcare professional to accommodate comorbidities. This ensures safety and maximises benefit from rehabilitation ¹.

Comprehensive cardiac rehabilitation should include health education, stress management, and psychological and social support, taking into account the physical and psychological status of the patient, as well as their work and social environment ¹.

Monitoring should be more detailed and frequent if the patient has significant comorbidities or if their condition has deteriorated, with intervals ranging from days to two weeks when clinical status or medication changes, and at least every six months for stable patients ².

For patients with heart failure, monitoring serum potassium and renal function is particularly important, especially if they are on medications such as aldosterone antagonists or digoxin, to prevent complications ²,¹.

Patients should be offered personalised, exercise-based cardiac rehabilitation programmes unless their condition is unstable, and the programme should provide a range of exercise options suitable for people of all ages and those with significant comorbidity, without excluding patients who choose not to attend specific components ¹,².

Engagement strategies include delivering rehabilitation in a culturally sensitive, non-judgemental manner, considering language and cultural diversity, and addressing barriers to attendance such as transport or timing. Early initiation of rehabilitation, within 10 days of hospital discharge, and follow-up reminders for non-attenders improve participation ¹.

Involving partners or carers in the rehabilitation programme can provide additional support for patients with comorbidities ¹.