Full course of cardiac rehabilitation reduces
risk of myocardial infarction and death for elderly patients with cardiovascular
disease
Elderly patients with heart disease who attended more
cardiac rehabilitation sessions had fewer heart attacks and were less likely to
die within four years than those who went to rehab less, researchers report in
Circulation: Journal of the American Heart Association.
Researchers analyzed data from 5 percent of the nation's
Medicare beneficiaries that included more than 30,000 patients age 65 and older
who had gone to at least one cardiac rehabilitation session between the 2000 and
2005. When examining those who went to cardiac rehab, investigators learned: The
more sessions, the better.
"We were not surprised that patients who attended more
rehabilitation had better outcomes," said Bradley G. Hammill, M.S., lead author
of the study. "We need to encourage physicians to recommend cardiac rehabilitation
to eligible patients, and we need to encourage those patients to attend and stay
with it."
Medicare reimburses 36 sessions, yet about half of these
Medicare-enrolled patients attended 24 or fewer, said Hammill, senior biostatistician
at the Center for Clinical and Genetic Economics at Duke Clinical Research Institute
in Durham, N.C.
Researchers found:
- Patients who attended all 36 sessions lowered their risk of myocardial infarction
and death when compared to patients who went to fewer sessions.
- Those who attended 36 sessions had a 14 percent lower risk of death and a
12 percent lower risk of myocardial infarction compared to those who attended
24 sessions.
- Those who attended 36 sessions had 22 percent lower risk of death and 23
percent lower risk of myocardial infarction compared to those who went to 12 sessions.
- Those who attended 36 sessions had a 47 percent lower risk of death and a
31 percent lower risk of myocardial infarction than those who went to only one
session.
Hammill and his colleagues conducted the study to determine
if there was a best "dose" of cardiac rehab that would help patients the most.
Typically, people attend cardiac rehab two to three times
per week for six to eight weeks, he said. The program is designed to fit each
patient's abilities and needs and typically includes counseling about cardiovascular
disease, nutrition, reducing stress, how to properly use medications and any emotional
concerns. A physician supervises an exercise plan, and a rehab program can also
include:
- Counseling on understanding and managing the disease process, good nutrition,
modifying risk factors and appropriate use of prescribed medications
- Vocational guidance to enable the patient to return to work
- Information on physical limitations
- Emotional support
Patients are usually referred to a cardiac rehabilitation
facility after a heart attack, coronary bypass surgery, heart transplant or other
cardiac interventions. Rehab is also used for the long-term management of angina,
which is chest pain caused by clogged or narrowed arteries.
"Unfortunately, use of cardiac rehab is very low," Hammill
said. "Under 20 percent of those eligible ever go and women and minorities go
less often than white men. We need to promote cardiac rehab for everyone."
Hammill said he will continue studying the use of cardiac
rehab.
"An important point about cardiac rehabilitation is that
each visit involves interaction with a healthcare provider," he said. "And there
is benefit to having contact with the medical system."
Co-authors are: Lesley H. Curtis, Ph.D.; Kevin A. Schulman,
M.D.; and David J. Whellan, M.D., M.H.S. Author disclosures are on the manuscript.
This study was funded by grants from the National Institute
on Aging and the National Heart, Lung, and Blood Institute.
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