May 16, 2011 -- Sticking with a cardiac rehab program in the aftermath of heart surgery can be a real lifesaver, according to a new study by researchers at the Mayo Clinic.
The study showed that patients who participated in a program that combined exercise, nutrition, and counseling were more likely to live longer after a percutaneous coronary intervention (PCI), in which plaque-clogged heart arteries are unblocked. The procedure is also known as an angioplasty.
The researchers reviewed the outcomes of Mayo Clinic patients who had undergone a PCI during the 14- year period from 1994 to 2008. Of the nearly 2,400 records they reviewed, those patients who had participated in the clinic’s cardiac rehab program were nearly 50% less likely to die than patients who had not participated. The outcomes were similar regardless of whether the patient was a man or woman, younger or older.
Cardiac rehab programs are designed to improve a patient’s heart health. Individually tailored to each patient’s needs and risk factors, they include personalized exercise regimens and healthy eating plans, along with mental health counseling when needed and group classes for support. Nurses, exercise specialists, nutritionists, and psychologists often make up a patient’s rehab team, which is overseen by a doctor.
Despite the high success rate of cardiac rehab among patients who have coronary artery disease, particularly those who have had a heart attack, the programs remain underused.
“About 50% nationwide are referred, about half of those attend, and of those who do attend, only about half complete the standard 36 sessions,” says study researcher Randal J. Thomas, MD, director of the Mayo Clinic’s Cardiovascular Health Clinic in Rochester, Minn.
One of the biggest hurdles had been the cost, but in 2006, Medicare agreed to cover cardiac rehab following PCI, reimbursing patients for about 80% of the cost. At the Mayo Clinic, the number of rehab sessions that a patient receives is assigned based on how well he or she is doing after surgery. In the study, the average number of sessions was 13.5.
“Higher-risk patients often get the full 36 sessions,” says Thomas, “while someone doing well might receive as few as eight.”
Doctors Influence Rehab Rates
Thomas says that there are numerous reasons that patients drop out of rehab or don’t participate at all. Some lack insurance, others might live too far from a center for it to be convenient, and some patients are simply not interested in attending.
“But the strongest predictor of a patient’s participation in rehab is whether or not their physician endorses it strongly,” says Thomas.
This study, he hopes, will encourage such strong endorsement.
“There is evidence that rehab referral rates are improving,” Thomas says, “but there is still a lack of information on its benefits for both physicians and patients.”