25 Sep 2017
When Elizabeth, a 76-year-old woman who had heart valve surgery, began her outpatient cardiac rehabilitation program, she used a walker. Halfway through the 12-week program, Elizabeth started using a cane. By the end, she was walking on a treadmill without assistance. Her mood was positive and she was doing her hair and makeup again. After only three months, Elizabeth had greatly improved her quality of life.
If a person suffers from a cardiac event or has heart issues, cardiac rehabilitation (CR) helps them recover physically and emotionally, reducing their risk of more heart problems. Murray Low, EdD, the program director of Cardiac Rehabilitation at Burke Rehabilitation Hospital and Stamford Hospital, suggests that cardiac rehabilitation is “the most beneficial thing that someone can do following a diagnosis of coronary artery disease. There are dozens of studies that show mortality can be reduced by anywhere from 30 to 60 percent if someone attends a cardiac rehab program.” CR also significantly reduces the risk of hospital readmission, according to the American Heart Association.
CR is a medically-supervised exercise, education, and counseling program to improve heart health if one has had: myocardial infarction (heart attack), coronary bypass surgery, cardiac valve replacement, stent placement, angina, or congestive heart failure. Most insurance plans, Medicare, and Medicaid provide coverage for these conditions. If a patient has not been referred but thinks they are eligible, Dr. Richard Novitch, Medical Director of Cardiac Rehabilitation at Burke, recommends they ask their doctor if they are a candidate for CR.
Phase One of CR occurs in the hospital after the patient’s cardiac event. Phase Two, an outpatient program lasting three months, includes 36 one-hour sessions of telemetry-monitored aerobic exercise, supervised by an exercise physiologist and monitored by a physician. The medical professionals ensure a patient doesn’t have shortness of breath, chest pain, or an arrhythmia. People may be fearful of exercising after cardiac issues and this helps them build stamina and confidence. In Phase Three, a patient progresses to fitness maintenance without monitoring.
“Having a cardiac event can be an emotionally devastating event. About 50 percent of people who have a cardiac event can develop a clinical depression,” says Dr. Novitch. At Burke CR, a cardiac life coach provides group therapy and can refer a patient to a psychiatrist if necessary. Also, nutrition classes are essential for educating patients about healthy eating, and meditation classes focus on stress reduction.
CR patients meet others who have similar health concerns. This social aspect of the program helps improve a patient’s mood. According to Meghan Marone, an exercise physiologist at Burke, “It’s encouraging for the patients to see the progress that other patients have made because then they see that they’re able to make progress also.”
Marone says CR is beneficial for increasing a person’s exercise capacity and strength, as well as improving their blood pressure control and glucose control (if diabetic). Participants are inspired to continue their healthier lifestyle because they feel better.
While cardiac rehab is effective and is covered by Medicare and Medicaid, it is underutilized. Only 20 to 30 percent of patients who are eligible for CR use it.
Unfortunately, doctors don’t refer enough of their patients for CR. Dr. Low states that physicians are trained to diagnose patients, and treat them with procedures and medications. While doctors know about the benefits of exercise, he states, “No one in medical school is trained to teach you to change your lifestyle.”
Dr. Novitch thinks that sometimes doctors require more training in collaborative care. CR is multidisciplinary and doctors often have to “cede their responsibilities to other professionals” in order for it to work. Also, he believes physicians would prescribe CR if referrals were more “automatic,” which may happen in the future with physician-support software.
Marone suggests that patients, especially women, don’t have time for cardiac rehab because of work and family obligations. Extended CR hours can help. Other obstacles to participation may include the co-payment cost and/or transportation issues.
While CR isn’t used as much as it should be, Dr. Novitch states that it “is a very inexpensive, effective way to help patients.” He says, ”There are very few things in medicine as cost-effective as cardiac rehab…. It’s a no-brainer.”