By AMERICAN HEART ASSOCIATION NEWS
Cardiac rehabilitation could help the roughly 965,000 Americans who suffer a coronary event each year, as well as patients diagnosed with heart failure. Yet research has found that only one-eighth of all eligible Medicare beneficiaries participate in cardiac rehab programs.
Cardiac rehab is a medically supervised program that includes exercise training, education on heart-healthy living and counseling to reduce stress. A 2014 study found that heart attack survivors who participate in cardiac rehab are 42 percent less likely to die than those who don’t participate. They are also 25 percent less likely to be readmitted to the hospital.
So why is the service underutilized?
The reasons are plentiful, experts say, and include a lack of referral from the patient’s doctor, no health coverage, the cost of copays and a dearth of program availability near the patient’s home.
In response, survivors and members of Congress are calling for expanded access to cardiac rehab programs.
Legislation is under consideration in both the U.S. House and Senate – H.R. 3355 and S. 488, respectively. Under current law, a doctor must be within walking distance of a program when cardiac rehab services are being furnished in order for that program to be reimbursed by Medicare.
The proposed legislation would allow physician assistants, nurse practitioners and clinical nurse specialists to directly supervise cardiac rehab programs on a day-to-day basis under Medicare. This would allow programs to operate in rural areas where doctors are scarce and reduce costs for urban programs.
Two-time heart attack survivor Jen Thorson of St. Paul, Minnesota, felt safe and well-supervised by her team of physician assistants and nurse practitioners.
After her first attack in fall 2011, she was referred to cardiac rehab at discharge from the hospital.
“I have come to understand that a referral may not be standard procedure for all patients. That amazes me because cardiac rehab was absolutely critical to my recovery and my mental health after my heart attack,” she said.
“You can’t just be discharged from the hospital with a pile of pills and be expected to just figure everything out on your own.”
Thorson, an avid runner before her heart attacks, said the physical components of rehab were vital to reclaiming her exercise confidence.
“When I got to rehab I was excited to exercise but comforted by the fact that I was hooked up to monitors and there were people who knew what to do if something went awry,” she said.
The “safe environment” allowed Thorson to take more risks than she would have if she had chosen to recover at home.
Thorson said the program’s cardiac risk modification components, such as behavioral counseling and nutrition education, also proved to be essential in her recovery. She attended the program three hours a week for 12 weeks.
“Being with trained exercise physiologists, nutritionists and a team of people who know about heart disease gave me accountability and a community,” she said.
Thorson’s life returned to normal, but almost a year after her heart attack, she suffered another blockage and minor heart attack. Thinking she could handle her recovery alone, Thorson refused a second go-round at rehab.
“This quickly proved to be a mistake. My second heart attack hit me harder than the first one. I was sicker. I felt worse. I was depressed. And I was on the couch and could hardly do anything,” she said.
“I shouldn’t have assumed I could do it on my own. Nobody should think they should do it on their own, and no one should have to try.”
What people need to remember, Thorson said, is that a heart attack is a long-term illness that must be managed.
“And that’s what rehab does,” she said. “Surviving the heart attack is what the hospital stay is about, but living with heart disease – that’s why we have and need rehab.”
Photo by Emily Steffen