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Put your heart in the right place

Cardiac rehabilitation can speed recovery from heart-related surgery and lower the risk of heart attack and stroke.

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Cardiac rehab programs are designed for patients who have recovered from a recent heart attack or heart failure, or who have undergone surgery for a heart valve, coronary artery bypass, pacemaker, or stent. They are also helpful for people diagnosed as having a high risk for cardiovascular disease.

“Patients often do well in the programs, and they definitely can improve recovery and future heart health,” says Dr. Pradeep Natarajan, a cardiologist with Harvard-affiliated Massachusetts General Hospital. “Yet, many providers don’t offer rehab, and most patients don’t know about it.”

How cardiac rehab works

Most cardiac rehab involves up to 36 sessions, two or three times a week. The hour-long sessions incorporate exercise, nutrition counseling, medication management, smoking cessation, lifestyle analysis, and psychological services to help with depression, stress, and anxiety.

The exercise portion may include walking on a treadmill or riding a stationary bicycle, along with light stretching and resistance training. It is monitored and adjusted based on an individual’s heart rate. You first will undergo a thorough exam and risk factor assessment followed by stress tests and scans to determine your individual exercise plan.

Multiple clinical trials have shown that rehab patients reduce shortness of breath and are better able to perform daily activities, such as walking short distances and climbing stairs. They also are less likely to re-enter the hospital and to die over a given period.

Despite these impressive outcomes, many eligible people do not take advantage of the programs, according to a study in the Aug. 25, 2015, Journal of the American College of Cardiology. Researchers found that among 100,000 people with heart failure who were eligible for cardiac rehab programs, only 10.4% were referred.

It is not clear why this happens. However, a likely contributing factor is that the programs are still somewhat unknown, says Dr. Natarajan.

“Even though the benefits have been previously recognized, coverage by Medicare and Medicaid only began a few years ago, so both patients and providers may be unaware of this opportunity,” he says.

Patients should be more proactive and ask their physician if they would benefit from a cardiac rehab program and, if so, request a referral.

Overcoming barriers

Even when people are referred, many face barriers that cause them to drop out. The most common involves transportation, such as traveling long distances, and time conflicts with work or other commitments.

“Yet many rehab centers can help solve problems with travel as well as adjust sessions to better fit a person’s schedule,” says Dr. Natarajan.

Slow recovery from heart problems also can hamper attendance. Many patients are weak after their heart attack or surgical procedure, which can make initial attendance difficult.

And keep in mind that while Medicare, Medicaid, and many insurance plans cover the rehab, a copay is still required. The amount is based on the individual’s policy and can vary from $15 to $100 per session.

Cardiac rehab takes commitment, but the potential rewards are well worth it. “It has its challenges, but it can be one of the best ways to improve your heart health, especially after a heart attack or heart-related surgery,” says Dr. Natarajan.

Prepping for rehab

Tests and scans to help determine the exercises and intensity levels that are safe for you may include the following:

  • Resting electrocardiography (ECG) measures the electrical signals that control the rhythm of your heartbeat.

  • Exercise electrocardiography records the electrical activity of the heart during exercise to evaluate how the heart responds to exertion.

  • Echocardiography uses sound waves to produce an image of the heart to show how well it pumps blood.

  • Cardiac perfusion scan estimates the amount of blood that reaches the heart muscle during rest and exercise.

  • Ambulatory electrocardiography (Holter monitoring test) uses a wearable device to monitor the electrical activity of your heart while you go about your daily activities.

Posted by: Dr.Health

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