Cardiac Rehabilitation Helped Shire McNamara Focus on Recovery

Early in 2022, Shire McNamara was sitting at her desk at Adventist HealthCare Adventist Medical Group, where she works as a practice manager, when she experienced what she thought was a perimenopausal hot flash.

“I just became so incredibly hot,” Shire said. “My collarbone hurt, but I was so hot, I wanted to take off my clothes.”

Shire assumed the feeling would pass, but her coworkers took one look at her and knew whatever was happening was not a hot flash.

“We went downstairs to the primary care offices, and a doctor gave me an EKG,” Shire said. “The test said that I was in the middle of a heart attack. I told them that they must not know how to read an EKG.”

Out of the Hospital, Into Cardiac Rehab

Shire’s right ventral artery had an 80% blockage, and she received a cardiac catheterization and stent placement. As many patients who have had a serious cardiac event do, Shire received a recommendation to begin cardiac rehab, but like many patients in her situation, she wasn’t quite sure she needed it.

“Nationally, cardiac rehab is underutilized,” said Michelle Babcock, PT, MPT, NCS-Emeritus, MHA, associate vice president of operations in Post-Acute Care at Adventist HealthCare Rehabilitation. “Only 30% of people who should receive rehabilitation after a cardiac event receive it, and those numbers drop off even more for women and people of color.”

After much encouragement, Shire began cardiac rehab at Adventist HealthCare Rehabilitation, a program certified by the American Association of Cardiovascular and Pulmonary Rehabilitation that serves patients who have experienced myocardial infarction as well as those managing coronary artery disease and other complex cardiac conditions. She worked with the program’s team of exercise physiologists, registered nurses and a medical director to improve physical functioning and make the lifestyle changes necessary to improve her long-term health.

Each patient who attends our two-part program receives an individualized rehabilitation plan, which may include working with a dietitian, different physician specialists and mental health providers.

“Our medical director has oversight of all the plans, and he can provide guidance when there’s a question about the patient’s ability to tolerate the program,” Michelle said. “Each patient receives the dosage of exercise and targeted interventions that are most appropriate for them.”

Patients at all levels of physical abilities can attend, as well.

“Often, cardiac rehab is perceived as being for only people who can exercise in a traditional sense,” Michelle said. “We have the equipment and ability to work with patients with functional limitations and limited mobility.”

Exercise comprises only half of a patient’s care plan. Education about better nutrition, medication adherence, smoking cessation and stress reduction to lower the risk of future cardiac events is a vital component.

“The exercise is important, but so often it’s the consistent education and one-on-one behavioral counseling that really spurs patients like Shire to commit to significant changes,” said Lauren Conley, MS CEP, clinical manager of Outpatient Cardiac Rehabilitation at Adventist HealthCare Rehabilitation. “The education and counseling can really help push patients to that place where they’re ready and able to commit to significant behavior changes for the better.”

Demonstrable Results

Nine months after her heart attack, Shire, now 44, is enjoying improved health. The high blood pressure and diabetes she had before the heart attack are under control, and she’s tapering off medications.

“I went from somebody who would walk the dogs a couple of times a week for exercise to now going to the gym at least three times a week,” Shire said. “Cardiac rehab has been essential for me to learn how to change my life. And it was such a positive experience to be surrounded by others who had been through what I had, which was key for my mental health.”

Shire is not alone in her success. In the past year at Adventist HealthCare Rehabilitation cardiac rehab:

• Between 75% to 89% of patients have had a 40% or higher improvement in their metabolic equivalents.
• 89% of patients have achieved a level of moderate exercise intensity.
• 84% of patients have lowered their blood pressure to 130/80 mmHg.
• 86% to 100% of patients completed cardiac rehab with a decrease in depressive status measured by patient health questionnaires (PHQs) by one tier or with no depressive status at all.
• Between 90% to 94% of patients who entered cardiac rehab completed the entire program.

Shire’s levels topped Adventist HealthCare Rehabilitation averages.

“She actually achieved a 118% improvement in overall exercise levels, which is phenomenal,” Lauren said. “She had significant increases in her PHQ levels, lowered her blood pressure and achieved vigorous exercise capacity. So, on a clinical level, she blew it out of the water.”