By Deborah Jeanne Sergeant
Cardiac rehabilitation can help patients who have experienced a heart attack reduce their risk of experiencing another heart attack and other cardiac events.
While a mainstream practice now, promoting these programs began in the 1970s. They were not widespread until the mid-2000s. Before this point, post-heart attack patients were told to rest and avoid performing hard work. Return to anything close to their pre-heart attack life? Forget about it.
“Fortunately, due to significant advancements in medical therapeutics, we are now able to help patients who have survived a heart attack live substantially longer lives and have a better quality of life, too,” said David Bass, doctor of osteopathic medicine. Bass is board-certified in cardiovascular disease and internal medicine and practices at Oswego Health.
“For patients that have survived a heart attack, it’s extremely important for them to know that they are not completely out of the woods,” Bass added. “The chances of them having another heart attack, developing congestive heart failure, or having a potentially lethal cardiac arrhythmia are substantially higher.”
After a heart attack, patients learn what happened to them and why — along with what they can do to lower the chances of it happening again. As an active participant in their own healthcare, patients learn about the changes they can make to get better.
All that information can be a little overwhelming, so patients should bring along a helper to provide a second set of ears and take notes.
Most patients will receive up to five medications, some long-term and others short-term, to perform tasks like lowering cholesterol, controlling blood pressure, prevent blood from coagulating, and more. These medications allow the heart to recover and help the patient get vital numbers under control.
Patients also will plan follow ups with a cardiologist and primary care physician to monitor their health. Other risk factors to work on can include smoking cessation and weight loss.
The plan for rehabilitation also includes teaching patients how to safely become fitter, improve their diet, and enhance their emotional health. It is not a matter of a short-term fix but lifestyle modification to gain and maintain wellness.
“Establishing ongoing care with a cardiovascular specialist that you come to feel comfortable with is extremely important,” Bass said.
As a result of their new lifestyle, patients may experience reduced need for medication, prevent future hospital admissions, become stronger, lose weight and better manage stress.
“We want you to not only survive but thrive and get back to the level you were before,” said physician Seth Jacobson, director of the Cardiac Rehabilitation Program at University of Rochester Medical Center. “We rehab people back to their condition before — and better. We can improve their endurance and confidence.
“We also screen for depression. That happens in one-quarter of those who have a heart attack. We think that people who have symptoms of depression are more likely to have a heart attack. It’s really something that should not be ignored. Depression factors into cardiac disease and leads to worse outcomes afterward.”
Patients also meet with a dietitian to plan how to eat better and with an exercise physiologist for help in learning how to exercise. Cardiac rehabilitation lasts 36 sessions. Patients go twice weekly.
Those who follow through with cardiac rehab reduce their risk of another significant cardiac event by 25 to 50%.
Insurance covers the rehabilitation with co-pays and those with Medicaid or Medicare pay very few fees. Jacobson said that since the rehabilitation is so important, his organization works with people who struggle to cover the co-pays. Social workers can help arrange transportation for those who lack it.
Despite its importance, most patients do not follow through with cardiac rehab. Jacobson estimated only 20 to 25% of those eligible participate.
“Some patients don’t feel like going,” Jacobson said. “Some of it is because their doctors don’t recommend it strongly enough.”
Insurance usually covers cardiac rehab for chronic heart disease such as coronary artery disease or chronic systolic heart failure and patients who have had a heart procedure or surgery.