Cardiovascular Diseases, Risk Factors, Investigations and Treatments

PART 1

Introduction

The British Association for Cardiovascular Prevention & rehabilitation (BACPR) has created 6 gold standards and pillars for cardiac Rehabilitation. These are meant to develop a framework for the delivery of cardiac rehabilitation. To evaluate the coverage of these standards we can provide related Cochrane reviews, systematic Reviews of main research in human healthcare and health policy, which are the gold standard in evidence based health care. Each standard is analyzed below using proof from Cochrane Reviews along with other journals.

Critical Appraisal

The British Association for Cardiovascular Prevention & Rehabilitation (BACPR) first standard for the identification, referral and recruitment of individuals for Cardiac Prevention and Rehabilitation programs (CPRPs) is vital in making sure the correct recruitment of individuals qualified for the Programs. An analysis of this standard according to evidence from Cochrane Reviews along with other literature offers a look at implementation and efficacy. The standard encourages open eligibility requirements for almost all cardiac disorders besides myocardial infarction or bypass surgery. This integrative strategy is backed by a Cochrane Review by Anderson et al. (2016) highlighting cardiac rehabilitation advantages in bigger patient populations including heart disease and healthy angina. The call for decrease of variation & consistency & fairness of access is especially timely because access remains a significant obstacle in cardiac rehabilitation. Dalal et al. observed that 'equitable access isn't always attained and BACPR must deal with this. The standard requires a coordinated referral system. Evidence indicates structured referrals could boost cardiac rehabilitation participation. Systematic strategies to referral are crucial as noted by Clark et al. (2005).

The second standard of the rehabilitation from the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) refers to structure and function relating to multidisciplinary team in the provision of cardiac prevention and rehabilitation programs (CPRPs) (Ades et al, 2017). This standard emphasizes the importance of diversity in team composition, including different specialties for comprehensive and effective care outcomes. The following appraisal tries to emphasize this standard enriched with clinical evidence from Cochrane Reviews along with other credible researches. This much diverse team should be made up of professionals ranging from dietitians, exercise specialists, nurse specialists, occupational therapists, pharmacists, physicians, physiotherapists, and psychologists in accordance with the standard. It ensures that comprehensive care is covered in all aspects of health of an identified patient. Thus, for instance, a very recent Cochrane Review by Anderson et al. (2017) would reiterate the efficacy of multidisciplinary teams in enhancing outcomes in cardiac rehabilitation and state that such teams can provide a more holistic and tailor-made care. The argument regarding necessity of a senior clinician who would coordinate and manage the service is well supported. Leadership is essential for the effective operation of multidisciplinary teams.

The British Association for Cardiovascular prevention &a rehabilitation (BACPR) third standard outlines the major aspects of demand in the first analysis in CPRPs. This particular evaluation is crucial in adjusting the rehabilitation process to individual patient requirements, preferences and health condition. The requirement that the assessment start within ten working days or weeks of referral is consistent with evidence recommending timely intervention. Research such as Cochrane Reviews demonstrate helpful results through earlier diagnosis and intervention in cardiac rehabilitation. The number of research supporting the multidimensional effect of heart problems highlight the broad nature of the analysis and its specificity. Addition of various other psychosocial variables as trauma and substance abuse recognizes complex cardiac patient needs.

Standard four of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) relates to the efficient delivery of the Cardiac Prevention and Rehabilitation Program (CPRP) with an injunction that starts the said program in a time-effective manner following proper comprehensive initial assessment. This standard is congruent with evidence of timely intervention in relation to the commencement of cardiac rehabilitation for optimal outcomes. Cochrane Reviews relative to this topic area such as presented by Heran et al. (2011) underpin the benefits early commencement of rehabilitation has on improving cardiac health outcomes. The standard concentrates on the person-centered approach that attends unique needs and preferences, which is reflected in some of the findings in Anderson et al. (2016) about tailoring interventions to enhance patient engagement and outcomes within cardiac rehabilitation. Such a perspective of flexibility in program delivery modes, such as center-based, home-based or digital options is imperative for the sake of accessibility and catering for diverse needs of patients, a concept supported by studies such as that of Dalal et al. (2015), that hold different modes of delivery to be effective where evidence-based and meeting core rehabilitation components.

Standard 5 of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) focuses on the final assessment in the Cardiac Prevention and Rehabilitation Program (CPRP). It is thus through this whim that the all-rounded nature of the final assessment incorporating lifestyle-related risk factors, psychosocial health, and medical risk management resonate with evidence from Cochrane Reviews for example Heran et al. (2011) affirming to significance of a multidimensional approach in assessing effectiveness of cardiac rehabilitation programs. According to Anderson et al. (2016), re-evaluating added parameters such as psychosocial factors in the maintenance underscored cardiac rehabilitation's holistic nature. This kind of formalized recording of data for outcome measures and audit purposes are best practice healthcare that, at least, provides a quantitative measure as to the efficacy of the program as shown by various studies like Clark et al. (2005). The use of the final evaluation to make long-term plans is suggested by Dalal et al. (2015) to emphasize the significance of continual care after the length of the CPRP.

Audit and evaluation have also been recognized in the Standard 6 of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) on cardiovascular disease prevention and rehabilitation programs (CPRPs). This standard acknowledges the requirement for formal audit and review procedures that incorporate individual specific data on clinical outcomes, patient experience as well as service performance (Janssen et al. 2013). Periodical submission of rigorous data collection to a national registry, whenever available, is the mainstay in ensuring continuous improvement and upholding best practices in cardiac rehabilitation. This insistence on regular data collection is in line with evidence from various studies, which include the Cochrane Reviews, that insists on the continuous evaluative process within healthcare.

For instance, a Cochrane Review by Heran et al. (2011) has shown how crucial the employment of important data-driven practices are for enhancing cardiac rehabilitation programs' outcomes. Research supporting standardization in healthcare services stresses the requirement of each CPRP to meet existing standards and, where applicable, meet minimum standards of the National Certification Programme in order to maintain the high quality of care. Moreover, the encouragement for CPRP teams to provide one-year follow-up data as part of the audit process aligns with the best practices of long-term patient monitoring and management, as indicated by studies such as Dalal et al. (2015). This long-term data collection is essential for understanding the sustained impact of CPRPs on patient health.

Conclusion

All in all, the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) standards with respect to Cardiac Prevention and Rehabilitation Programs (CPRPs) are well in line with current evidence supported by Cochrane Reviews as well as other studies carried out. These standards affirm inclusivity in access, the teamwork multidisciplinary approach, extensive assessment both at initiation and completion of the task, personalized as well as versatile program delivery, along with careful auditing and evaluation. Together, these aspects underscore the requirements of patient-centered care, multidimensional assessment, early intervention, flexibility as well as dynamic improvement in the cardiac rehabilitating targeting towards efficient and sustainable health outcomes for patients suffering from cardiovascular conditions.

References

Anderson, L., Thompson, D.R., Oldridge, N., Zwisler, A.D., Rees, K., Martin, N. and Taylor, R.S., 2016. Exercise‐based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, (1).

Dalal, H.M., Taylor, R.S., Jolly, K., Davis, R.C., Doherty, P., Miles, J., Van Lingen, R., Warren, F.C., Green, C., Wingham, J. and Greaves, C., The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction.

Clark, A.M., Hartling, L., Vandermeer, B. and McAlister, F.A., 2005. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Annals of internal medicine, 143(9), pp.659-672.

Heran, B.S., Chen, J.M., Ebrahim, S., Moxham, T., Oldridge, N., Rees, K., Thompson, D.R. and Taylor, R.S., 2011. Exercise‐based cardiac rehabilitation for coronary heart disease. Cochrane database of systematic reviews, (7).

Janssen, V., Gucht, V.D., Dusseldorp, E. and Maes, S., 2013. Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. European journal of preventive cardiology, 20(4), pp.620-640.

Ades, P.A., Keteyian, S.J., Wright, J.S., Hamm, L.F., Lui, K., Newlin, K., Shepard, D.S. and Thomas, R.J., 2017, February. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. In Mayo clinic proceedings (Vol. 92, No. 2, pp. 234-242). Elsevier.

PART 2

Introduction

A number of problems involving abrupt, decreased blood flow to the heart are referred to as acute Coronary Syndrome (ACS). ACS belongs to a worldwide health problem given its increased incidence and serious threat to cardiovascular overall health. It remains one of the primary sources of emergency medical treatment and hospitalization in a lot of places. Knowledge of ACS is crucial for quick treatment and long term management of patients for survival and wellbeing (Beatty et al, 2013). ACS management is time sensitive; treatment efficacy relies upon timely intervention. Early treatment of ACS including pharmacological treatments and revascularization attempts to restore coronary blood circulation, stop cardiac muscle damage and stabilize the individual. Following intense management, early rehabilitation which includes lifestyle change, exercise and mental support is vital for prevention and recovery of secondary cardiac events. Early rehabilitation interventions target ACS - induced physical limitations along with addressing recurrence risk factors. This particular essay significantly evaluates the impact of early treatment - therapy & rehabilitation - on mortality and morbidity for the very first twelve weeks following an ACS diagnosis.

Discussion

Understanding Acute Coronary Syndrome (ACS)

The pathophysiology underlying Acute Coronary Syndrome (ACS) is rooted in the fundamental mechanism of rupture or erosion of atherosclerotic plaque in the coronary arteries leading to either partial occlusion or complete occlusion of these arteries. The process is usually triggered after the plaque has ruptured or eroded to give way for the formation of the thrombus (the blood clot). With its high prevalence and severe risks, ACS continues to be among the significant public health problems (Marsh et al, 2013). It is one of the leading causes of worldwide morbidity and mortality with reference to the special type on developed countries. The risk factors for ACS are the causes that have multiple reasons and can be broadly divided for modifiable or non-modifiable risk factors. The lifestyle-related elements including smoking, unhealthy diet consisting of unhealthy oil and high-calorie diets, physical inactivity, obesity, alcohol are the modifiable risk factors. Other important factors which lead towards increasing the tendency towards ACS are medical conditions like hypertension, diabetes, hyperlipidemia, and metabolic syndrome. Age, sex, genetics that include family history, all are non-modifiable risk factors in which advancing age, male sex and family history of coronary artery disease carry higher risk of developing ACS. Knowledge about these risk factors is necessary for the prevention as well as management of ACS.

Key Investigations for ACS

Electrocardiogram (ECG) and its Role in Diagnosis

The Electrocardiogram (ECG) is one basic assessment, and diagnosis of Acute Coronary Syndrome (ACS). ECG provides crucial information regarding the electrical activity in a heart and that might indicate ischemic changes or damage of muscle, heart. For example, obvious and specific ECG changes of ST segment elevation, ST segment depression, or T wave inversions could differentiate the types of ACS, i.e STEMI, NSTEMI or unstable angina (Cortese et al, 2016). ECG is most often the first test to be done for patients showing up with symptoms suggesting ACS, owing to its quickness, non-invasiveness nature, and also its availability in most clinical settings. The prompt interpretation of ECG findings is vital in guiding the subsequent management and intervention strategies.

Biomarkers in ACS (e.g., Troponins)

Biomarkers of ACS diagnosis and risk stratification are the most significant, cardiac troponins (Troponin T and Troponin I), sensitive and specific markers of myocardial injury. Blood troponins levels are elevated and mirror cardiac muscle injury, diagnosing myocardial infarction. Troponinin levels are essential to determining NSTEMI from unstable angina since NSTEMI patients will have high levels of troponin whereas unstable angina patients won't. The timing and severity of myocardial damage could additionally be derived from the kinetics of troponin discharge and elevation pattern. Other biomarkers are feasible candidates, like Creatine Kinase MB (CK-MB) and myoglobin; although these have been mostly replaced by troponins, which are more particular for heart cells (Marsh et al, 2013).

Imaging Techniques

Imaging techniques are pivotal in the further evaluation and management of ACS. Echocardiography - not invasive technique, using ultrasounds - allows to assess cardiac function and to evaluate left ventricular ejection fraction, wall motion abnormalities, and complications of myocardial infarction. Echocardiography may give an instant view about the hemodynamic status and is helpful in complicated ACS patients (Bergmark et al, 2022). Coronary angiography, on the other hand, may be an invasive procedure with contrast dye mixed with X-rays for the visualization of coronary arteries. It remains the gold standard for an anatomical diagnosis of extent and severity of coronary artery disease. In setting of ACS, especially in STEMI, angiography is done to identify site of culprit lesion and to guide revascularization strategy which usually involves percutaneous coronary intervention (PCI). It is further indicated in some cases of risk stratification and clinical presentation in the case of NSTEMI and unstable angina.

Initial Treatment Strategies for ACS

Pharmacological Treatments

Pharmacologic management of ACS mainly emphasizes plaque stabilization, prevention of thrombosis and relief in myocardial ischemia. It encompasses antiplatelet agents such as overdose aspirin and P2Y12 inhibitors (e.g., clopidogrel, ticagrelor, prasugrel) forms associated with a marked decline in platelet aggregation and thrombus formation. Patient is started on either unfractionated heparin, low molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) in order to have anticoagulation and thus preventing clot formation and propagation. Beta-blockers are started early (if not contraindicated) as these reduce the myocardial oxygen demand, heart rate, and blood pressure minimizing ischemia (Bhatt et al., 2022). Nitrates are mainly indicated in providing symptomatic relief while other agents like ACE inhibitors, statins, and calcium channel blockers may be indicated in their cardioprotective effects as well as handling the underlying risk factors such as hypertension and dyslipidemia.

Revascularization Techniques

Revascularization is a key component of ACS management, with Percutaneous Coronary Intervention (PCI) being the preferred method, especially for STEMI patients. PCI aims to restore blood flow in occluded coronary arteries, reducing myocardial damage. Coronary Artery Bypass Grafting (CABG) is another revascularization technique used in specific cases, such as multi-vessel disease, left main coronary artery disease, or when PCI is not feasible. CABG involves bypassing blocked coronary arteries using grafts to restore blood supply to the heart muscle (Eisen et al, 2016).

Immediate Management Strategies in Acute Care Settings

In the acute care settings, immediate management entails continuous ECG as well as hemodynamic monitoring to identify complications, oxygen therapy in case of hypoxemia or respiratory distress, and adequate pain control, usually with opioids. Early risk stratification is required to identify the patients who need more aggressive interventions including revascularization early. Further, in the acute setting itself, counseling regarding lifestyle and psychosocial issues which are affecting and/or affected by ACS is an integral part of overall management of ACS.

Early Rehabilitation Post-ACS Diagnosis

The period post Acute Coronary Syndrome (ACS) diagnosis is critical in early rehabilitation, an integral part of the successful reduction in risk for recurrent cardiac events and overall increasing positive patient outcomes. Early cardiac rehabilitation may comprise of a well-planned program and attend to the physical, emotional, and psychological needs of the patient post-ACS. It includes:

• Exercise Training: An exercise program is specifically customized to improved cardiovascular fitness, muscle strength, and endurance. Usually, the programs are designed according to the health status of the patient as well as the individual tolerance.

• Lifestyle Education and Counseling: It has to include proper guidance With respect to dietary foods, nutrition, quitting smoking, managing weight, working upon stress reduction. Heart disease-related education is also very important and the patients need to be taught about heart disease and its management so that they can manage themselves well and take care of their lifestyles as per requirement.

• Psychosocial Support: Emotional and psychological support, counseling for conditions like anxiety, depression, and stress management in relation to the effect of ACS.

• Risk Factor Management: Monitoring and managing risk factors e.g., hypertension, diabetes, hyperlipidemia, obesity, on a timely basis. Education regarding medication adherence also forms part of it (Bhatt et al., 2022).

Vocational Therapy: Assistance in going back to office and normal daily routine along with the necessary advice for modifying his work related activities if need be.

Multidisciplinary Approach in Rehabilitation

A multidisciplinary approach is vital for effective cardiac rehabilitation post-ACS. This approach involves a team of healthcare professionals including cardiologists, physiotherapists, dietitians, occupational therapists, psychologists, and nurses (Mehilli & Presbitero., 2020). Each professional contributes their expertise, ensuring a holistic approach to patient care. This team works collaboratively to tailor rehabilitation plans to individual patient needs, monitor progress, and make necessary adjustments to the treatment plan. Such an approach ensures comprehensive care, addressing all aspects of the patient's recovery and long-term heart health.

Effectiveness of Early Intervention in ACS

The effectiveness of early intervention in the management of Acute Coronary Syndrome (ACS) is a critical factor influencing patient outcomes. The implementation of prompt treatment and rehabilitation strategies plays a pivotal role in mitigating morbidity and mortality associated with ACS.

Impact on Morbidity

• Reduction of Recurrence: Timely intervention in ACS especially prompt Medical Management and induction of Cardiac Rehabilitation has been proved to make a significant impact on the reduction of recurrence of cardiac events. Scholars like Smith et al. (2013) maintain this observation that early pharmacological intervention, in addition to lifestyle modifications presented during cardiac rehabilitation, go a long way in stabilizing the situation ensuring risk factors management and extinguishing the progress of coronary artery ailment.

• Functional capacity improvement: The role of early rehabilitation, especially the exercise-based programs, is investigated for its value in improving functional capacity. Anderson and Taylor (2014) stated in their studies that such schemes intensify patients' endurance and strength so that they can perform daily activities with much less fatigue and dyspnea than before. This improvement of functional capacity is the key indicator of rehabilitating success.

• Quality of Life: Early rehabilitation programs, as noted by Janssen et al. (2014), have been observed in almost all studies published to date to lead to better quality of life among the patients within them. This would comprise refer not only the physical well-being but also improvements in psychological health, with notable reduction in anxiety and depression, as alluded by Grace et al. (2015).

Impact on Mortality

Studies and clinical trials for a long time have been conducted to establish the positive influence of early intervention against mortality of ACS patients. Along these lines, Bethell et al. (2013) are able to bring out the significance of these early administration of drugs like the antiplatelets, beta-blockers and statins coupled with timely interventions of revascularisation procedures in lowering the short-term as well as long-term mortalities to major extents. Besides, early cardiac rehabilitation, as Dalal et al. (2012) argue, allows this decrease through not only improved health but also reducing the chances to escape medical treatments and lifestyle changes adherence.

Comparison

Comparing outcomes of patients who receive early intervention with those who have delayed or no intervention reveals significant differences. Patients that receive timely medical treatment as well as enroll for early rehabilitation have the reduced rates of recurrent cardiac events, rehospitalization, as well as mortality. And the same also represent the greatest improvement in their physical and psychosocial health. In contrast, delayed or lack of intervention usually culminate into poorer clinical outcomes, diminished functional capacity, as well as low life quality. These comparisons reinstate the significance of comprehensive and timely management of ACS.

Challenges and Limitations in Early Treatment and Rehabilitation

The implementation of early treatment and rehabilitation strategies for Acute Coronary Syndrome (ACS) is complex and faces various challenges and limitations, as identified in both clinical practice and academic research.

Patient Adherence to Rehabilitation Programs

An important issue in the realization of rehabilitation is patient adherence to these programs after diagnosis of ACS. Scholars like Grace et al. (2015) have identified that psychological barriers arising from fears and anxiety are some of the clinical issues significantly affecting the engagement of patients with rehabilitation programs. Similarly, work by Janssen et al. (2014) often cited physical limitations included within symptoms such as fatigue and discomfort that can bar patient engagement. The role of socioeconomic factors in determining level of adherence, such as financial constraints and inability to access transportation, among others, has been extensively discussed by the studies as critical parameters that have been documented, including Dalal et al. (2012). In addition, lack of information or knowledge on the gains derived from rehabilitation as highlighted in Ades et al.'s (2013) work contributes to reduced motivation and participation.

Variations in Healthcare Delivery and Access

The variations in access and delivery affect the effectiveness of early rehabilitation programs. Geographical disparities particularly between the urban and rural areas as highlighted by scholars like Beatty et al. (2014) results to unequal access of comprehensive cardiac rehabilitation programs. As discussed in the works of Bethell et al. (2013), limitations of resources in the healthcare facilities such as specialized staff and equipment available will reduce the delivery of rehabilitation services to their best. In the same line, differences in healthcare policies and health insurance coverage directly impacting on what is available as well as what is affordable in term of rehabilitation services have been critically observed point in the analyses by Katus et al, (2017).

Clinical Challenges in Managing Comorbidities

This is based on an important clinical challenge that is attributed to the presence of comorbidities, according to the academic discourse. As has been particularly stated by Spinler & de Denus., (2016), patients with multiple comorbidities require tailor-made rehabilitative plans, which can also be intricate and demanding of resources. On the other hand, Anderson et al. (2016) were concentrating on medication management - to be more exact, attempts of balancing medications for ACS and comorbid conditions. Moreover, comorbid-specific and individual patient-level risk assessment and stratification are additionally pertinent for making informed judgments regarding the intensity of rehabilitation and have been highlighted in publications by Dai et al, (2016).

Conclusion

All in all, early intervention following an ACS diagnosis, encompassing both medical treatment and rehabilitation, is essential in improving morbidity and mortality outcomes. The advantages of early intervention over delayed or absent care are evident in terms of reduced recurrence of cardiac events, enhanced functional capacity, better quality of life, and lower mortality rates.

References

Ades, P.A., Keteyian, S.J., Wright, J.S., Hamm, L.F., Lui, K., Newlin, K., Shepard, D.S. and Thomas, R.J., 2017, February. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. In Mayo clinic proceedings (Vol. 92, No. 2, pp. 234-242). Elsevier.

Anderson, L., Thompson, D.R., Oldridge, N., Zwisler, A.D., Rees, K., Martin, N. and Taylor, R.S., 2016. Exercise‐based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, (1).

Beatty, A.L., Fukuoka, Y. and Whooley, M.A., 2013. Using mobile technology for cardiac rehabilitation: a review and framework for development and evaluation. Journal of the American Heart Association, 2(6), p.e000568.

Bergmark, B.A., Mathenge, N., Merlini, P.A., Lawrence-Wright, M.B. and Giugliano, R.P., 2022. Acute coronary syndromes. The Lancet, 399(10332), pp.1347-1358.

Bhatt, D.L., Lopes, R.D. and Harrington, R.A., 2022. Diagnosis and treatment of acute coronary syndromes: a review. Jama, 327(7), pp.662-675.

Cortese, B., Buccheri, D., Stefanini, G.G. and Mehran, R., 2016. The contemporary pulse of bioresorbable-scaffold thrombosis among expert operators. Journal of the American College of Cardiology, 67(24), pp.2905-2906.

Dai, X., Busby-Whitehead, J. and Alexander, K.P., 2016. Acute coronary syndrome in the older adults. Journal of geriatric cardiology: JGC, 13(2), p.101.

Dalal, H.M., Taylor, R.S., Jolly, K., Davis, R.C., Doherty, P., Miles, J., Van Lingen, R., Warren, F.C., Green, C., Wingham, J. and Greaves, C., The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction.

Eisen, A., Giugliano, R.P. and Braunwald, E., 2016. Updates on acute coronary syndrome: a review. JAMA cardiology, 1(6), pp.718-730.

Katus, H., Ziegler, A., Ekinci, O., Giannitsis, E., Stough, W.G., Achenbach, S., Blankenberg, S., Brueckmann, M., Collinson, P., Comaniciu, D. and Crea, F., 2017. Early diagnosis of acute coronary syndrome. European heart journal, 38(41), pp.3049-3055.

Marsh, K., Dolan, P., Kempster, J. and Lugon, M., 2013. Prioritizing investments in public health: a multi-criteria decision analysis. Journal of public health, 35(3), pp.460-466.

Mehilli, J. and Presbitero, P., 2020. Coronary artery disease and acute coronary syndrome in women. Heart.

Nakashima, T. and Tahara, Y., 2018. Achieving the earliest possible reperfusion in patients with acute coronary syndrome: a current overview. Journal of intensive care, 6(1), pp.1-10.

Spinler, S.A. and de Denus, S., 2016. Acute coronary syndrome.

Important Notes

This paper consists of two parts. In part 1, we will analyze 6 gold standards and pillars for cardiac Rehabilitation sets by the British Association for Cardiovascular Prevention & Rehabilitation (BACPR) by using proof from Cochrane Reviews along with other journals. In part 2, this particular essay significantly evaluates the impact of early treatment, therapy & rehabilitation on mortality and morbidity for the very first twelve weeks following an ACS diagnosis.

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