Health & Fitness
Benefits of cardiac rehabilitation
LINGAPPA AMARCHAND, MD
Published: March 2, 2011
Cardiac rehabilitation substantially improves outcomes and is the most under utilized, despite proven benefits.Published: March 2, 2011
Patients need to participate in cardiac rehabilitation to achieve optimal results.
Combining exercise training with multi-faceted strategies aimed at reducing modifiable cardiovascular risk factors, such as smoking, hypertension, diabetes, dyslipidemias, obesity and stress in a cardiac rehabilitation program, is associated with lower mortality and recurrent myocardial infarction (MI) rates.
A recent study in the Journal of American College of Cardiology found Medicare patients who participate in cardiac rehabilitation after hospitalizations for coronary heart disease or coronary revascularization are associated with mortality rates of 21 to 24 percent lower than those patients who did not attend cardiac rehabilitation programs.
Rehabilitative services are not adequately used by patients.
Todd M. Brown, M.D., a cardiologist from UAB Medical Center Alabama states, despite proven efficacy, cardiac rehabilitation programs are under utilized.
The physician awareness about the benefits of cardiac rehabilitation is lower than for other interventions.
Among the reasons for this treatment gap are physician's barriers, such as lack of awareness, lack of motivation and insufficient time and resources.
Previous studies have reported that reminders such as prompts to family physicians are effective to reduce the treatment gap.
The American Heart Association (AHA), American College of Cardiology and American Association of Cardiovascular and Pulmonary Rehabilitation provides recommendations for cardiac rehabilitation for patients after MI or revascularization with coronary artery bypass or coronary angioplasty, as well as for individuals with stable angina as part of their guidelines.
In a recent data analysis from the AHA's, Get with Guidelines program (GWTG), Brown and others found only 56 percent of eligible individuals received referrals to CR programs.
From the 72,817 people discharged from GWTG hospitals from January 2000 to September 2007, only 40,974 were referred to cardiac rehabilitative services.
"Substantial variation exists among hospitals in the percentage of eligible patients referred to cardiac rehabilitation." Brown said.
In 35 percent of hospitals, less than 20 percent of eligible patients were referred and only a third of the physicians referred more than 60 percent of eligible patients, according to the analysis. Physicians referred patients undergoing coronary artery bypass grafting most frequently. Other factors independently associated with referral included younger age ST-segment elevation MI and a history of dyslipidemia or smoking.
Individuals with co-morbidities and older patients were less likely to be referred despite recent evidence that these populations benefit from cardiac rehabilitation.
A wider range of patients benefit from cardiac rehabilitation than has previously been described. Cardiac rehabilitation programs improve exercise capacity, lipid profile, better blood sugar control, hypertension and smoking cessation.
It has also been found in some studies that age was not a significant predictor of achieving secondary prevention goals of cardiac rehabilitation.
Researchers compared changes in selected measures between cardiac rehabilitation entry and completion among younger (<65 years) and older (>65 years) patients. Both groups experienced significant improvement upon completing cardiac rehabilitation programs.
Moreover, benefits extended to the oldest patients, those older than 75 years, as many of whom had a higher co-morbidity burden than did younger patients. Recent Medicare data also shows older patients accrue a mortality benefit.
Brooksville Regional Hospital offers a Cardio-Pulmonary Rehabilitation program combining comprehensive medical management, patient education, to speed recovery, improve individuals overall physical and mental functioning and slow or reverse disease progression.
Patients may also consult with dietitians, diabetes educators, psychologists and other health care specialists.
The ultimate goal for patients who participate in cardiac rehabilitation programs is allow for the achievement of an ideal setting where they can develop systemic interventions to help them reduce their risk and effectively achieve optimal health outcomes.
It is important to maintain the benefits gained from the program once the patient is back to usual care.
Also the use of letters of recommendations for the generalists is an efficient and applicable to ensure the maintenance of patient benefits following the cardiac rehabilitation program.
For more information about the Cardio-Pulmonary Rehabilitation program at Brooksville Regional Hospital, please contact Dee West, RN, coordinator for the cardiac rehabilitation at 352-799-3565 or Melissa Coredeiro with Cardiology Associates at 352-683-6057.
Dr. Lingappa Amarchand, M.D., cardiologist with Cardiology Associates in Brooksville and serves as medical director for the Cardiac Rehabilitation program at Brooksville Regional Hospital.