One of the most underutilized treatments for heart patients may also be one of the most effective, new research suggests.

The longer patients in the study participated in cardiac rehabilitation programs following heart-related hospitalizations, the better their outcomes were.

The goal of cardiac rehabilitation is to slow or even reverse the progression of cardiovascular disease by educating patients about their disease and having them follow a medically supervised exercise program.

Sessions are typically held two or three times a week for several months after a heart-related hospital discharge, but only about 10% to 20% of patients who could benefit from the programs actually attend them, rehab specialist David Prince, MD, of Montefiore Medical Center tells WebMD.

"Many eligible patients are never referred for cardiac rehab and access is also an issue," Prince says.

Cardiac Rehab: More Is Better

Medicare recipients are entitled to 36 cardiac rehab sessions following hospitalization for heart attacks, bypass surgery, or many other heart-related events, yet most eligible patients end up attending far fewer sessions or none at all.

In an effort to determine if more is better when it comes to cardiac rehabilitation, researchers analyzed data from 5% of the nation's Medicare beneficiaries, including more than 30,000 heart patients who had participated in at least one cardiac rehabilitation session between 2000 and 2005.

About half the patients attended 24 sessions or fewer, biostatistician and study researcher Bradley G. Hammill, MS, tells WebMD.

Over roughly four years of follow-up, patients who attended all 36 reimbursed sessions were:

• 47% less likely to die and 31% less likely to have a heart attack as patients who attended just one.
• 22% less likely to die and 23% less likely to have a heart attack than patients who attended 12 sessions.
• 14% less likely to die and a 12% less likely to have a heart attack than patients who attended 24 sessions.

The study will appear in the upcoming issue of the American Heart Association journal Circulation.

"Our findings indicate that more cardiac rehabilitation is better in almost every situation," Hammill says. "It may be that people who finish 36 sessions are already healthier or more diligent about their health. Or it may be that the programs really do change behaviors and lower risk."

Daisy McFadden's Story

99-year-old Daisy McFadden has been attending Montefiore Medical Center's Cardiac Recovery Program for 11 years, ever since she had triple bypass surgery at the age of 88.

Three times a week, McFadden works out at the center, following an exercise program developed and supervised by the center's medical team.

She monitors her own pulse and heart rate while she performs both aerobic and weight-bearing exercises on seven different machines, including a treadmill and rowing machine.

"I look forward to going," she tells WebMD. "It gets me out and gives me a place to go. That is important."

A retired nurse, McFadden worked for the New York City department of health for 34 years from 1938 until 1972. She still lives independently and credits the program, healthy living, and a positive attitude for her long life.

Earlier this month, McFadden celebrated her birthday at Montefiore with friends, family, and program staffers.

"I am very particular about my nutrition," she says. "I am careful about having three meals a day, and including fresh vegetables and fruits. And I stay away from negative people, places, and things."

Physician Referral a Problem

The study did not examine why so many eligible patients never attend cardiac rehab programs or go for only a few sessions.

Prince, who runs the Montefiore program, says one big obstacle has been that cardiologists and other referring physicians have been slow to recognize the impact of the programs on patient recovery.

"It has been shown that the single most important factor in patients being compliant with cardiac rehabilitation is the strength of the recommendation of the referring physician," he says.

Prince's desk sits in the middle of a gym, surrounded by treadmills. As patients exercise, he and other staffers monitor them.

While exercise is a big part of the program, there is much more to it, he says. The Montefiore program also emphasizes psychological support and education.

"When I started in this field, I thought it was all about the exercise," he says. "Exercise is important, but these programs also give patients structure, positive reinforcement, and an opportunity to meet other heart patients and realize they are not alone."

Cardiologist and American Heart Association spokesman Gerald Fletcher, MD, of the Mayo Clinic, Jacksonville, agrees.

"There are about 1 million heart attacks every year in the United States," he tells WebMD. "In addition to teaching people important tools, these programs help patients realize they are not alone."

SOURCES: Hammill, B.G. Circulation, Jan. 5/12, 2010; online edition.

Bradley G. Hammill, MS, senior biostatician, Duke University School of Medicine, Durham, N.C.

Gerald Fletcher, MD, spokesman, American Heart Association; professor of medicine, Mayo Clinic College of Medicine, Jacksonville, Fla.

David Prince, MD, director, Cardiac Recovery Program, Montefiore Medical Center, Bronx, N.Y.

Daisy McFadden, retired nurse, Bronx, N.Y.

News release, American Heart Association, Dec. 21, 2009.

American Heart Association: "Cardiac Rehabilitation."

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