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Cardiac rehab is often the best medication for recovery

One advantage of attending cardiac rehab is the power of the group support, which can provide added motivation.
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Participation in a cardiac rehabilitation program following a heart attack helps people live longer and better.

In the aftermath of a heart attack or coronary procedure, you typically leave the hospital with a sheaf of prescriptions for an array of new heart medicines. But all too often, a referral to a cardiac rehabilitation program is missing from your pile of paperwork.

Taking part in a multiweek program of structured exercise paired with lifestyle and nutrition education is a well-documented method for improving quality of life and maybe even the likelihood of survival after a heart attack or surgery. But only about two-thirds of people who have undergone a procedure for coronary artery disease are referred for cardiac rehabilitation by their physicians, according to a study in the May 2015 Journal of the American College of Cardiology. Of those, only about a quarter actually attended, and a mere fraction completed the recommended 36 sessions.

Gaps in rehab referral

Why do so few people take advantage of this important therapy? There are many reasons, says Dr. Donna Polk, medical director of the cardiac rehabilitation program at Harvard-affiliated Brigham and Women’s Hospital. “For younger people, the physician may say, ‘Oh, you’re going to be healthy, just start walking more.’ With very elderly patients, doctors often mistakenly assume the person will not reap much benefit from a rehab program.” In either case, she says, the lack of a referral represents a lost opportunity to improve the person’s health and function.

For some, the costs and logistics of attending rehab prevent their participation. Although Medicare and many other insurance plans cover cardiac rehab programs following most heart surgeries and procedures (see box), the copays may be too steep for people on a limited income. Also, people may have difficulty arranging regular transportation to rehab sessions, which are usually held two to three times a week for 12 weeks. Also, rehab centers are sparse in some rural areas. Unfortunately, research shows that some types of people who may benefit the most from cardiac rehab—including older people, minorities, and women—are even less likely to be enrolled. However, says Dr. Polk, once a referral is made, doctors and hospital-based patient support services can often help people overcome the other barriers.

Not just the gym

A popular misconception among both doctors and patients is that cardiac rehab is tantamount to supervised treadmill walking. In reality, it’s much more, says Dr. Polk. Your cardiac rehab team is made up of an exercise physiologist or physical therapist as well a nurse, a nutritionist, and a psychologist or social worker. The team assesses each per-son’s risk factors for heart and blood vessel disease; provides information about medicines, nutrition, and stress reduction; and encourages behavior changes. “Rehab is a chance for people—no matter what their disease stage—to reassess all their lifestyle choices and move in new directions,” Dr. Polk says.

One notable advantage over the lifestyle changes you may attempt on your own is the power of group support. The anxiety many people feel after a cardiac event can be overwhelming. Professional guidance, coupled with motivation from fellow cardiac patients, helps people achieve visible gains in strength and stamina. This in turn leads to greater confidence and helps them shed the perception of being a “cardiac cripple.”

What you can do

If your doctor hasn’t recommended cardiac rehab, be sure to ask about it. Another avenue is to find a program in your area and ask them to contact your doctor for the referral. A good place to start is the online directory of cardiac rehab programs maintained by the American Association of Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org).

Meanwhile, efforts are under way to make cardiac rehab more accessible. Pilot programs have tested combinations of home-based exercise and smartphone apps that track heart rates, lipids, and other metrics. Future options may include text-message coaching and online social media communities.

Who’s eligible for cardiac rehab?

Medicare Part B covers comprehensive cardiac rehabilitation programs for the following conditions if you have a referral from your doctor:

  • a heart attack in the last 12 months
  • coronary artery bypass surgery
  • current stable angina
  • a heart valve repair or replacement
  • a coronary angioplasty or coronary stent
  • a heart transplant or heart-lung transplant
  • stable chronic heart failure

Posted by: Dr.Health

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