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Don’t skip cardiac rehab after a heart event

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Cardiac rehab cuts death risk and improves lives.

If you had a serious heart problem and there was an extremely safe, proven treatment to reduce risk factors for heart disease—and if it was covered by Medicare and most health insurance plans—would you take it?

An expert medical association calculates that only 14% to 35% of heart attack survivors and only 31% of bypass patients get it. Some never hear about it from their doctors. Others—older women in particular—tend not to use it, even when their doctors prescribe it.

It’s called cardiac rehabilitation. And it may not be what you think it is, says Dr. Daniel Forman, director of the exercise testing lab at Brigham and Women’s Hospital and assistant professor at Harvard Medical School.

Cardiac rehabilitation is a structured program that includes exercise; education aimed at reducing risks such as smoking, high blood pressure, high cholesterol, and a less-than-healthy diet; and psychological and social support.

“For reducing deaths and increasing quality of life, cardiac rehab exceeds any pill, any procedure,” he says. “Whether it’s getting a patient through a heart attack, placing a stent, or repairing a heart valve, what helped people get through their cardiac event will only be meaningful if we maintain that benefit. Cardiac rehab is an opportunity to do just that.”

Is rehab for you?

Cardiac rehab is an individualized program of exercise, education, nutrition, and psychological/ social support.

Medicare and many other insurance plans cover a cardiac rehab program if you’ve had a heart attack, angina, angioplasty or stents, open-heart surgery (bypass or valve surgery, for example), or a heart transplant. Dr. Forman says many others also would benefit, such as people with heart failure, peripheral artery disease, diabetes, obesity, and other heart disease risks such as high cholesterol.

“Older people across the board would benefit,” he says. “The irony is that those who would benefit most—people at an advanced age, minorities, women—are less likely to be offered rehab.”

That’s because cardiac rehab centers in many cities are few and far between. Insurance reimbursement to the professionals who staff them is low, and transportation is a major issue for many people who need it most.

Cardiac rehab isn’t a gym

Yes, exercise is a big part of cardiac rehab. But there’s a lot more to it than that. “Cardiac rehab doesn’t entirely reproduce the gym,” Dr. Forman says.

The medical professionals who make up a cardiac rehab team include a physiologist or trainer, a nurse, a nutritionist, and a psychologist or social worker. The team assesses each person’s individual risk factors for heart and blood vessel disease

  • teaches—and supports—healthy lifestyle changes, including weight control, establishing a heart-healthy diet, quitting smoking, and avoiding secondhand smoke

  • develops a personalized exercise plan for each person, then helps get that plan started and shows how to integrate exercise into daily routines

  • monitors and helps control blood pressure, cholesterol, and blood sugar

  • assesses psychological problems, such as depression, related to heart disease and provides counseling

  • helps people learn from and aid others with similar heart issues

  • improves people’s communication with their doctors and other health care providers.

“Cardiac rehab is an opportunity to reinforce people’s confidence in physical activity and healthy diet; to reduce their anxiety; to help them understand their disease, their medications, and their self-care,” Dr. Forman says.

Finding a cardiac rehab program

If your doctor hasn’t recommended cardiac rehab, ask about it. “This is more of a priority than it once was, yet many doctors forget to refer people to rehab programs,” Dr. Forman says.

The American Association of Cardiovascular and Pulmonary Rehabilitation maintains an online directory of cardiac rehab programs at www.aacvpr.org. Meanwhile, Dr. Forman and other specialists in the field are working to find ways to make cardiac rehab more accessible to people who live in rural areas or who find it hard to get to a rehab center.

Posted by: Dr.Health

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