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Send more patients for cardiac rehab, doctors urged

It has long been known that getting heart patients into rehabilitation programs can reduce their risk of early death by about 25 per cent: Lifestyle changes are just as effective as common drug therapies such as baby Aspirin and cholesterol-lowering statins.

However, only 20 to 30 per cent of cardiac patients who are prescribed medications sign up for rehab.

So Canadian researchers set out to determine how the numbers could be improved.

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What they found seems, in retrospect, glaringly obvious: Patients don't sign up for rehab because they don't get asked.

"Physician referral failure is a big reason people don't get there," said Sherry Grace, director of research for the cardiovascular rehabilitation and prevention program at the Peter Munk Cardiac Centre of the University Health Network in Toronto.

But she also found that how patients are asked matters, too.

"You need to talk to patients at the bedside. It's time-consuming, but it works," Dr. Grace said.

And the way to ensure that the chat occurs systematically is to place referral to cardiac rehab on a checklist of tasks (preferably with an electronic reminder) that need to occur before a patient is discharged.

A new study, published in the medical journal Archives of Internal Medicine, shows that those two simple measures – a checklist for health-care professionals coupled with a face-to-face talk with patients – resulted in 70 per cent of cardiac patients going to rehab.

Joe Walters, a 55-year-old supervisor for a credit-card company, spent eight days in hospital after being diagnosed with atrial fibrillation (abnormal heart rhythm) in August, 2009.

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He was referred to cardiac rehabilitation by his cardiologist, an experience he said opened his eyes and greatly improved his health.

"It was great to have a support network when I needed it," Mr. Walters said.

His cardiac rehab program consisted of 33 sessions with a variety of health specialists including a cardiac nurse, a kinesiologist, a dietitian and a personal trainer.

Mr. Walters managed to lose 30 pounds through a combination of exercise and diet, and he quit smoking and drinking. It has not cured his cardiovascular problems entirely, but the changes have taken a lot of strain off his heart.

Caroline Chessex, clinical director of the cardiac rehab and prevention program at the University Health Network, said that by changing their lifestyle, people can reduce their risk of a second heart attack or additional heart surgery.

She said rehab programs are tailored to the individual. "Our goal is to develop strategies for patients to reduce or eliminate their risk of coronary artery disease, prevent or minimize hospitalization, decrease mortality and improve quality of life."

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Research shows that rehab has benefits not only for individual patients, but for the health system as a whole.

Cardiac rehab programs cost about $1,500 per patient. By comparison, bypass surgery costs about $23,000. "The return on investment is obvious," Dr. Grace said.

She said more needs to be spent on prevention instead of just waiting for people to get sick again. "It makes no sense to discharge people back into the environment that gave them heart disease. We need to give them tools to care for themselves and improve the continuum of care beyond the hospital."

In 2007, the most recent year for which there are detailed data, there were 69,503 deaths from caused by heart disease and strokes, according to Statistics Canada.

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