Cardiac Rehabilitation Post-Angioplasty

"The use of cardiac rehabilitation after coronary stenting carries the strongest recommendation in our clinical practice guidelines."
"Unfortunately, the use of cardiac rehabilitation among eligible patients remains low."
"We found it interesting that there were a diverse set of factors associated with patients ultimately attending cardiac rehabilitation. This suggests that multi-faceted strategies, such as insurance redesign, may need to be tested and implemented to improve cardiac rehabilitation use."
Dr. Devraj Sukul, University of Michigan, Ann Arbor

"Ideally, cardiac rehab would be provided without cost to all patients who qualify regardless of financial ability."
"I think the one-on-one aspect -- and the fact they have been out of the hospital for about one week --  allows them to ask a lot of questions in a relaxed fashion, and then they see that this type of program has a lot to offer them."
"Even if a patient cannot attend all the sessions due to finances or distance or both, I encourage them to at least attend one or two sessions."
"They can learn a significant amount about diet and exercise and gain pointers on how to create their own program at home."
Dr. Ellen Keeley, University of Florida Health, Gainesville 

Cleveland Clinic exercise physiologist Audra DiRauso sets up an exercise bike for Anthony Rugare during a cardiac rehabilitation class in 2009. Despite benefits from rehabilitation such as better quality of life and lower rates of rehospitalization, patients may not attend. (Mark Duncan/Associated Press)

A Michigan study concludes that a mere one in three heart patients makes the effort to enrol in cardiac rehabilitation following a blocked heart artery clearance through stent insertion, despite the rehabilitation instruction being highly recommended as a follow-up therapy for its value in informing people post-surgery on best practices to enhance recovery and increase chances related to ongoing future heart health.

The obvious reasons that the health community urges heart patients following stent insertion to follow up with attending cardiac rehabilitation instruction is the acquisition of beneficial knowledge leading to better quality of life and lower rates of re-hospitalization. But realistically, it is also acknowledged that patients may hesitate to attend knowledge sessions as a result of insurance coverage, costs and access to a rehabilitation facility to begin with.

Doctors increasing their efforts to convince patients to take advantage of their referrals for cardiac rehabilitation has been a helpful strategy, but according to the authors of the paper, recently published in the Journal of the American College of Cardiology, more must be undertaken to ensure that patients are convinced despite inconveniences or cost, to attend such sessions.

Dr. Sukul and colleagues reached their conclusion after studying over 42,000 Michigan patient-records who had undergone percutaneous coronary intervention (PCI), a common process to clear a blocked heart artery which typically uses a tiny tubular stent to maintain open blood vessels. Their meta-analysis included the use of two databases of medical and health insurance records, enabling them to track patients who had been referred to cardiac rehab following care at one of 47 Michigan hospitals between 2012 and 2016.

Of particular interest to the researchers were the factors that came into play to influence patient participation in cardiac rehabilitation. Of 30,075 patients who were discharged to their homes with a referral for cardiac rehabilitation, the study team found that 8,000 had attended one session at least within 90 days following discharge. They found as well that people were likelier to attend if an "acute" reason such as certain types of heart attack mandated they do so.

Patients with additional chronic health conditions such as diabetes and peripheral artery disease were found to be less likely than others to attend rehabilitation. Those patients covered by Medicare Fee-For-Service insurance were less likely to attend cardiac rehabilitation than those covered by private Blue Cross Blue Shield of Michigan plans and among all patients with Medicare, those covered by Medicaid (state-run insurance plan for the poor) were even less likely to commit to attending a session.

Distance from a patient's home ZIP code to the nearest cardiac rehab session appeared to make no difference in who was likely to attend rehab but if the cardiac rehab location was over two miles' distance from the site where the PCI procedure took place, patients tended to be less likely to attend cardiac rehabilitation.

According to Dr. Keely of University of Florida, Gainsville, where she along with colleagues operate a clinic evaluating heart attack patients after hospital discharge, patients are more likely to enrol when they understand what such sessions involve; exercise, nutrition counselling and critically, smoking cessation. Dr. Keely feels that "pop-up" sites using community center space along with mobile units and telemedicine could become invaluable in helping those who live a fair distance from conventional cardiac rehabilitation sites.

Cardiac Rehabilitation (CR) is a program that combines lifestyle changes, education and supervised physical activity to help patients recover after cardiac events. Cardiac rehab has been demonstrated to reduce the likelihood for re-hospitalization, complications of cardiac disease, and sudden death.  Additional benefits of CR include improved quality of life and confidence with daily tasks. Patients report improvements in physical symptoms, blood pressure and lipid management, decrease in psychological distress, and marked improvement in quality of life.   Patients undergo a thorough evaluation by the clinical team before beginning the program. The evaluation includes an assessment of clinical history by our nursing team, lab work, and a stress test (if appropriate).  Upon enrollment, a team of certified clinical exercise physiologists prescribes an exercise program individualized for each patient and works with each patient for up to 36 sessions. Patients also have weekly interaction with our registered dietitians and social work can be consulted as necessary. The staff reviews the medication and works with the primary care physician and cardiologist to assure the patient is compliant with evidence based therapy
Cardiac Rehabilitation, University of Michigan