October 25, 2018 / 5:20 PM / 22 days ago

Heart patients should consider cardiac rehab

(Reuters Health) - Patients who have had a heart attack, stent placement or bypass surgery should strongly consider enrolling in a cardiac rehabilitation program, say the authors of a new patient resource published in JAMA Cardiology.

These programs focus on nutrition, stress management, exercise, psychological support, tobacco cessation and heart disease education. They not only help the heart recover, they can ease anxiety, reduce heart risk factors and improve quality of life, the authors write.

“There are short-term and long-term benefits to participating, including less chest pain, less depression, and a decreased risk of death from heart disease,” said Dr. Tamara Horwich of the University of California, Los Angeles, who co-authored the one-page primer for patients.

Horwich, who is medical director of UCLA’s cardiac rehab program, emphasizes the importance of lifestyle changes to prevent and reverse heart disease. She encourages patients to enroll in heart recovery programs for the group support and medically-supervised guidance.

“I tell my patients that if we work together, this heart issue doesn’t have to happen to them again,” she told Reuters Health by phone. “By taking the right medications and having a healthy lifestyle, repeat heart attacks won’t be a problem.”

Available for free, the new patient page (bit.ly/2ORMLnz) offers practical advice about joining cardiac rehabilitation programs.

“Unfortunately, patients who want to participate may face barriers such as insurance, transportation or time in their schedules,” Horwich said. “We need to work on addressing this.”

Horwich and co-author Dr. Gregg Fonarow, who is co-chief of UCLA’s cardiology division and co-director of its preventive cardiology program, first explain the goals of cardiac rehabilitation to halt or reverse the progression of heart disease. Aerobic exercise training is typically the cornerstone of these programs, but other key components focus on nutrition counseling and education about heart-related topics such as blood pressure, diabetes and cholesterol.

Usually based at a hospital or doctor’s office, cardiac rehab programs can include two or three one-hour sessions per week for 12 to 18 weeks, totaling about 36 hours. Intensive programs can continue for up to 72 hours.

“When you have a heart attack or undergo bypass or stenting, it’s a life-changing and often scary experience,” said Dr. Nieca Goldberg, medical director of the women’s heart program at New York University Langone Health in New York City.

“Often times, these patients didn’t exercise, were stressed and don’t know how to get started or get organized in taking care of various aspects of their cardiac health,” said Goldberg, who wasn’t involved in the patient resource.

The American Heart Association and American College of Cardiology highly recommend enrolling in these programs. Patients who take their medications and complete a cardiac rehabilitation program could reduce their risk of hospital readmission and cardiovascular death by 25 to 50 percent, according to the AHA. Plus, exercise capacity is likely to increase, and cholesterol, blood pressure and blood sugar levels should drop.

“These programs have been recommended for a long time because they really do improve patients’ quality of life,” Goldberg said in a phone interview. “At my practice, we always bring up cardiac rehab with patients.”

New studies are looking at ways to create remote or home-based cardiac programs by using smartwatches or monitors for heart rate, blood pressure and heart rhythm analysis. Then patients may be able to participate in group videos online from the comfort of their homes.

“We’re developing the program now and have the technology in place, so it’s a matter of getting the details of the program set,” Horwich said. “Plus, there are barriers to payment and insurance reimbursement for online programs, so we’re working on that as well.”

Following a cardiac rehab program, it’s important for patients and doctors to create a plan for what will happen after graduation, Goldberg said. By creating a plan and checking in, patients are more likely to stick with the lifestyle changes they’ve learned and continue to exercise, eat well and manage their stress.

“It’s a life-long process,” she said. “It’s not just about keeping patients out of the hospital but about healthy lifestyle choices that last.”

SOURCE: bit.ly/2ORMLnz JAMA Cardiology, online October 10, 2018.

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