**7. Management of Cardiac Rehabilitation**

**Jadwiga Wolszakiewicz, Ibrahim AlMalki, Mohammed AlShammari, Mishal AlHoti, Ibtihaj AlAsmari and Albandari AlAnazi**

## *7.1. Staffing*

The successful delivery of cardiac rehabilitation service requires a multidisciplinary team of professionals with appropriate qualifications and experience. Optimally, a cardiac rehabilitation team should comprise [1]:


The staff included will depend on local recommendations, staff availability, or the phase of cardiac rehabilitation. It is essential to assign specific duties to all staff members regarding staff competencies [2]. The cardiologist should serve as the medical director/be in charge of the cardiac rehabilitation department and should have sufficient experience with and profound knowledge of the management of cardiac rehabilitation centers. Medical director responsibilities include:


The position of medical director requires adequate organizational skills and experience to organize the program appropriately. The cardiologist evaluates a patient before commencing an exercise program, stratifies the cardiovascular risk, manages risk factors, and supervises exercise tests. Physiotherapists are responsible for the safe early mobilization of all eligible patients during phase I of cardiac rehabilitation, which typically occurs within an intensive care unit, coronary care unit, cardiology department, or cardiac surgery department. During supervised exercise sessions, exercise specialists are responsible for the proper implementation of exercise intensity and cooperate closely with a cardiologist in order to progress exercise training. Typically, one exercise specialist supervises five to ten low- or

intermediate-risk patients, and for high-risk patients the ratio should be lower [3]. For safety purposes, it is essential for at least two healthcare professionals to stay at the exercise training area during each exercise session. Nursing staff play an important role in managing medical emergencies and are usually responsible for education regarding diet, physical activities, and control of risk factors. The tasks of nutritionists include the assessment of nutritional status and dietary counseling, which is of particular importance in case of patients with diabetes and dyslipidemia. Psychologists conduct screening for psychosocial abnormalities—i.e., depression, anxiety, and post-traumatic stress disorder. Additional tasks of psychologists include the management of stress workshops and instructing patients regarding relaxation techniques. If available, social workers facilitate social reintegration and deliver vocational counseling in close cooperation with cardiologists [4]. Regular meetings of personnel—e.g., every week—are essential and provide the opportunity to discuss patient treatment plans or complex clinical cases in detail.
