By Steven Reinberg
health day reporter
WEDNESDAY, March 1, 2023 (HealthDay News) — After a heart attack, home rehab can literally be lifesaving, according to a new study.
Participation in a home cardiac rehabilitation program reduced the risk of dying from cardiac complications by 36% over four years, compared to patients who did not participate in a rehabilitation program, the researchers report.
“Cardiac rehabilitation programs save lives,” said lead researcher Dr. Mary Whooley, professor of medicine, epidemiology and biostatistics at the University of California, San Francisco.
According to the American Heart Association, which highlights the benefits of cardiac rehabilitation after a heart attack to prevent rehospitalizations and deaths, rehabilitation is vastly underused, with only 44% of patients choosing it.
Cardiac rehabilitation programs emphasize not smoking, eating healthy, exercising, managing stress, and taking medications to lower blood pressure and cholesterol.
Among patients hospitalized for a heart attack between 2007 and 2011, only 16% of Medicare patients and 10% of veterans participated in cardiac rehabilitation, the researchers said.
But if 70% of patients participated in cardiac rehabilitation, 25,000 lives could be saved and 180,000 hospitalizations avoided each year, according to the Million Hearts Cardiac Rehabilitation Collaborative, sponsored by the United States Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid. Services.
“Behavior change is really hard,” Whooley said. People get very motivated when they’re in the hospital and they’re sitting in bed and they think I never want to have a heart attack again. But then they come home and it’s pretty hard to get motivated to get outside and exercise and eat healthy and take good care of yourself.”
Home-based cardiac rehabilitation programs can be particularly effective, Whooley said.
“They may have longer lasting effects because people incorporate the behavioral changes into their regular lives instead of coming to the hospital and doing something and thinking they’re cured and going home,” he said. she explained. “The point is, you have to change your lifestyle. »
For the new study, Whooley and colleagues collected data on more than 1,100 veterans eligible for cardiac rehabilitation at the San Francisco VA Medical Center between August 2013 and December 2018. A total of 490 patients participated in the rehabilitation program at residence.
Over the 12-week program, participants received up to nine coaching calls, motivational talks, an exercise book, and a health diary to track vital signs, exercise, and diet. They also received a blood pressure monitor, a scale and a stationary bike. A nurse or exercise physiologist worked with the patients to create physical activity goals. Participants were followed for an average of four years after hospitalization.
The study found that 4% of those who did not participate in the rehabilitation program died within a year of being hospitalized, compared to 2% of those who participated in the home rehabilitation program.
During the four years of follow-up, 12% of rehabilitation patients died compared to 20% of those not in the program, the researchers found.
The results were published on March 1 in the Journal of the American Heart Association.
Two cardiologists not involved in the study recognize the importance of rehabilitation after a heart attack.
However, one barrier to home rehabilitation is the lack of insurance coverage, said Dr. Benjamin Hirsh, director of preventive cardiology at North Shore University Hospital in Manhasset, NY.
A bill before the US Congress that would approve home-based cardiac rehabilitation coverage for Medicare and Medicaid patients, but whether it will pass remains to be seen, Hirsh said. If so, private insurers are likely to follow suit.
“Cardiac rehabilitation is important because we know it improves quality of life and reduces the number of times patients come back for stents or have heart attacks and increases their longevity,” Hirsh said.
“You should enroll in a cardiac rehab program, either through the hospital or through virtual programming,” he said. “It’s available, it’s out there, so if you’re looking for it, you’ll find it.”
This is a landmark study of home cardiac rehabilitation and its effect on death rates, said Dr. Randal Thomas, professor of medicine at Mayo Clinic Alix School of Medicine in Rochester, Minnesota.
“His findings will help strengthen the case for home-based cardiac rehabilitation as Medicare and other insurers continue to decide how they will cover these important services,” he said.
Many eligible individuals do not receive cardiac rehabilitation due to various barriers including other time constraints, travel, and lack of insurance. In addition, many physicians do not refer patients and some health systems do not have home rehabilitation programs. Insurance co-payments can also be a significant hurdle, Thomas said.
“All patients should be encouraged to enter a cardiac rehabilitation program if they have had a heart attack, heart stenting, heart surgery, or have persistent heart pain,” Thomas said. “On average, it will help them feel better, do better, and live longer.”
To learn more about cardiac rehabilitation, check out the American Heart Association.
SOURCES: Mary Whooley, MD, professor, medicine, epidemiology and biostatistics, University of California, San Francisco; Randal Thomas, MD, professor of medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; Benjamin Hirsh, MD, director, preventive cardiology, North Shore University Hospital, Manhasset, NY; Journal of the American Heart Association, March 1, 2023, online