Mending broken hearts with cardiac rehab

The chances are high that you or someone you love will have a heart attack and survive it. But until I had a heart attack, I didn’t fully know that after surviving one there is a critically important option that very few survivors take advantage of. It’s called cardiac rehab, a medically supervised and supervised exercise program with counseling, diet, and other features.

After a seven-day hospital stay where I received an angioplasty, three stents, and a pacemaker, my cardiologist informed me about the cardiac rehab program at the hospital. It sounded great and I didn’t hesitate to get on the show. I had to wait a while while I recovered and then I had to pass a stress test to qualify for the program. But as soon as I could, I entered the award-winning program at Suburban Hospital in Bethesda, Maryland.

An individualized and personalized program was designed based on my medical condition and over time the program evolves to restore physical strength and endurance through the use of a variety of exercise machines. Rehabilitation programs also provide referring physicians with valuable monitoring information on their patients’ performance, information that can lead to new decisions about medical treatments or pharmacological interventions.

As I learned more about cardiac rehab, I was surprised to learn that approximately two-thirds of patients in the United States who survive a heart attack do not undergo outpatient cardiac rehab, even though these programs have been shown to reduce heart attack. risk of illness and death. and also to improve psychological recovery, according to findings reported by the Atlanta Centers for Disease Control and Prevention.

“There is a need to strengthen programs and policies aimed at increasing the number of patients who are referred and participate in cardiac rehabilitation,” the CDC researchers reported in a recent edition of the Morbidity and Mortality Weekly Report. “Future research should focus on identifying barriers to cardiac rehabilitation interventions and participation to improve referral and reception of outpatient rehabilitation services,” they added.

To estimate the use of outpatient cardiac rehab services among heart attack survivors, CDC researchers analyzed data from a 2005 survey where 129,416 people answered questions related to heart attack and cardiac rehab use. . Surprisingly, only 34.7 percent of heart attack survivors participated in outpatient cardiac rehabilitation, which typically includes a series of interventions to address modifiable cardiac risk factors, as well as psychosocial counseling. The District of Columbia had the lowest usage rate at 22.6 percent, while Nebraska had the highest rate at 59.1 percent.

Note that cardiac rehab is covered by Medicare and I suspect there are many other forms of health insurance, because its benefits are so safe.

In the CDC study, patients who were most likely to participate in rehab included men, age 49 and older, Hispanics, married patients, people with a college education, people with annual incomes of $ 15,000 or more, and patients who lived in the middle of a metropolitan area. Employment status and health insurance coverage did not have a statistically significant effect on whether patients attended rehabilitation.

In 2004, the Mayo Clinic reported: “Cardiac rehab increases the chances of surviving at least three years after a heart attack by more than 50 percent.” The Mayo study found that about half of the 1,821 eligible patients in a Minnesota county participated in a rehabilitation program.

And nearly half (48 percent) of deaths within three years of hospital discharge were attributed to not participating in cardiac rehab. “On average, for patients who participated in cardiac rehab, it was almost as if the heart attack had never happened. They had the same three-year survival that would be expected from area residents of the same age and sex who had not had attacks. heart disease, “said Veronique Roger, MD, a Mayo Clinic cardiologist who led the study. “Greater participation in cardiac rehabilitation could lead to better survival among a large proportion of heart attack patients.” Another finding was that women were less likely to participate in cardiac rehab.

In 2007, research from Brandeis University revealed that fewer than one in five (18.7 percent) patients receive cardiac rehabilitation services after a heart attack or coronary artery bypass surgery. However, bypass patients are much more likely (31.0 percent) than heart attack patients (13.9 percent) to receive rehabilitation.

The study evaluated Medicare claims data for 267,427 men and women 65 and older who survived at least 30 days after being discharged from the hospital following a heart attack or coronary bypass surgery in 1997. Despite Of Medicare coverage of cardiac rehabilitation services, women participated less than men, older patients less than younger ones, and non-whites far less than whites. There were large geographic differences in use, ranging from 53.5 percent of patients in Nebraska to 6.6 percent in Idaho.

In 2005, the American Heart Association said that physicians should strongly encourage patients to enter cardiac rehabilitation programs. “Cardiac rehabilitation programs remain underutilized in this country, with only 10 to 20 percent of the 2 million eligible patients a year who experienced a heart attack or underwent cardiac revascularization procedures participating,” said Arthur Leon, MD, chair of the writing group and Henry L Taylor, professor of exercise science and health improvement at the University of Minnesota in Minneapolis.

“In addition to a low rate of physician referral, factors that contribute to underutilization of services include lack of patient motivation and inadequate reimbursement from third parties. We need to motivate physicians to be more progressive in education and referral. patients to cardiac rehabilitation programs and motivate insurance companies to cover them. “

It was noted that research had found that average cardiac death was 26 percent lower in rehab patients who were exercise-trained compared to those who received “usual care.” There were also 21 percent fewer non-fatal heart attacks, 13 percent fewer bypass surgeries, and 19 percent fewer angioplasties in exercise-trained people.

Leon said that the specific benefits of the exercise training component are the improvement of the patient’s functional capacity, the improvement of blood vessel function, the improvement of cardiovascular risk factors, the improvement of coronary blood flow, the improvement of of the electrical stability of the heart muscle (thus reducing the risk of a fatal heart rhythm disturbance), reduction of the risk of blood clots and reduction of cardiac work and oxygen requirements.

In 2006, a Johns Hopkins University article reported: “A recent analysis examined the findings of 63 studies of cardiac rehabilitation programs involving more than 21,000 heart attack survivors. The results showed that participation in a rehabilitation program cardiac arrest reduced the chance of having a second heart attack within the next year by 17 percent; 2 years after the heart attack, overall mortality decreased by nearly 50 percent. “

In 2007, it was reported that research at Ochsner Medical Center, New Orleans, Louisiana found that the prevalence of depression decreased a significant 63 percent, from 17 percent to 6 percent, after rehabilitation. And depressed patients who completed cardiac rehab had a nearly 4-fold decrease in mortality compared to depressed patients who did not complete cardiac rehab (30 percent vs. 8 percent). They looked at 522 coronary artery disease patients averaging 64 years old and compared with a control group of 179 coronary artery disease patients who did not complete rehabilitation.

Clearly, there is no question about the benefits of cardiac rehab. Doctors, family and friends should strongly encourage heart attack survivors and those undergoing treatment for coronary heart disease to enter a cardiac rehabilitation program. It is just as important as taking prescription drugs and following a recommended diet.

My own experience, which includes hearing feedback from other longer-term participants, is participating in a formal cardiac rehab program, typically three days a week for twelve weeks, with the option of staying on a maintenance program , helps people stay engaged in regular physical activities. exercise. And this is surely important if losing weight is a goal.

It should be noted that research from the University of Toronto reported in 2005 found that the optimal time for a rehabilitation program is nine months. But the problem in the US is that Medicare and other forms of insurance only cover three months.

I want to emphasize the benefits of having professionals carefully and routinely monitor blood pressure and heart function at a time when one inevitably fears regaining physical strength and endurance after a heart attack. One feels safe exercising thanks to all the careful and close supervision. Confidence, confidence, confidence is a primary benefit of participating in a cardiac rehab program.

If fixing broken hearts is a priority, then clearly more needs to be done to get more heart attack survivors and heart disease patients into cardiac rehab programs. This is really sensible.