By Meagan Overman

For the Daily News

 

Heart disease remains the No. 1 killer in both men and women in the United States today and claims 600,000 lives per year. While there have been numerous advances in technologies and medications that have been shown to successfully treat heart disease, cardiac rehabilitation is a secondary prevention program that could be very beneficial but is severely underused. It utilizes education, individually tailored exercise training, risk factor modification and considers the overall well-being of the participants. The multidisciplinary staff may include but is not limited to physicians, nurses, exercise physiologists, respiratory therapists, dietitians and psychologists/counselors. Diagnoses that qualify an individual include stable angina, chronic heart failure, recent heart attack, coronary artery bypass graft surgery, coronary angioplasty, coronary stenting or heart transplant. The program is covered by most health insurances and includes up to 36 sessions at a frequency of three times per week. Each session typically lasts about an hour and includes monitored exercise training, education and counseling.

Education and counseling is an integral part of each session and topics may include physical activity/exercise, tobacco cessation, nutrition, and the management of blood pressure, psychosocial issues, weight, cholesterol, and diabetes. It is vital for participants to manage these areas of concern because they each play a role in the progression of heart disease. Regular exercise has been associated with a 28-percent reduction in all-cause mortality and a possible reduction in recurrent heart attacks. The overall mortality of smokers who quit decreases by 50 percent in the first couple of years and tends to approach that of non-smokers in 5-15 years of smoking cessation. A decrease in systolic blood pressure by 10 mmHg can decrease mortality by 20-40 percent and a decrease in diastolic blood pressure by 5-6 mmHg reduces the risk of cardiac events by 15 percent. Depression, anxiety, and denial occur in up to 20 percent of patients following cardiac events, and stress has been shown to be the third most important risk factor for cardiac events. Cardiac rehabilitation offers reduction in stress through exercise and stress management training.

Nutrition counseling in cardiac rehab aims to help participants understand the impact of food on one’s health and making healthy food choices. The dietitian will focus on helping develop healthy eating habits, reading labels, and specific recommendations for those with heart disease. Weight management is encouraged for most patients since reduction in body weight will positively impact other risk factors such as blood pressure, cholesterol and diabetes. The dietitian will also focus on lowering cholesterol values through encouraging a diet low in saturated fat. About 26 percent of cardiac rehabilitation participants are diabetic and tight control of blood glucose levels is tracked and encouraged.

Overall, the research suggests that cardiac rehabilitation reduces re-hospitalization rates, reduces recurrent sudden cardiac death, lessens the need for cardiac medications, and increases the rate of participants returning to work. Participants’ quality of life are improved through the reduction of symptoms (chest pain/angina, shortness of breath, and fatigue), stress reduction, and an enhanced sense of overall psychosocial well-being. One meta-analysis of 63 randomized trials (sample size: 21,295) showed a 17-percent reduction of recurring heart attack at 12 months and 47-percent reduction of mortality at two years with cardiac rehabilitation. Another meta-analysis of 48 randomized trials (sample size: 8,940) showed a significant reduction in all-cause mortality and cardiac mortality. In heart failure participants, a meta-analysis of nine randomized trials showed a 35-percent decrease in mortality. Cardiac rehabilitation participants who completed 25 or more sessions had a 20-percent lower 5-year mortality rate than those who attended less than 25 sessions.

The benefits of cardiac rehabilitation are very clear, however the referral and participation rates are low. In a recent study of more than 600,000 Medicare patients, only 12.2 percent (73,049) participated in cardiac rehabilitation. Another study that included 156 hospitals found that 56 percent of patients hospitalized for a cardiac event were referred to cardiac rehabilitation at discharge. There are many barriers that contribute to the participation in rehab. These barriers include age, sex, race, physician recommendation, patients’ beliefs about their illness, patient’s expectation about cardiac rehabilitation, feelings of self-efficacy, mood and coping style. Studies have shown there are inequalities in cardiac rehabilitation referral and participation. Women have poorer participation rates than men, and their barriers include lack of financial resources, transportation difficulties, and the lack of social or emotional support. Older individuals, although they have been shown to have excellent outcomes, are less likely to be referred and to participate in cardiac rehabilitation. Racial and ethnic minorities have higher rates of heart disease and related risk factors, however, are less likely to participate due to lack of accessibility, lack of insurance coverage and low patient referral rates.

Despite the numerous barriers to participate in cardiac rehabilitation, the benefit that may be achieved is worth the effort. Cardiac rehabilitation has been proven to be a safe and effective way of improving participants’ overall quality of life and also reducing their mortality.

Meagan Overman, MS, is a Clinical Exercise Physiologist at Vidant Wellness Center and can be reached at (252) 975-4236.