Getting Rehab at Home After Heart Attack Can Extend Lives

 

After a heart attack, home rehab can literally be a lifesaver, a new study finds.

Taking part in a home-based cardiac rehabilitation program lowered the risk of dying from heart complications by 36% within four years, compared with patients who were not in a rehab program, researchers report.

According to the American Heart Association, which stresses the benefits of cardiac rehabilitation after a heart attack in preventing rehospitalization and deaths, rehab is greatly underused -- with only about 44% of patients opting for it.

Among patients hospitalized for a heart attack between 2007 and 2011, only 16% of Medicare patients and 10% of veterans took part in cardiac rehabilitation, the researchers said.

Cardiac rehabilitation programs stress not smoking, eating healthy, exercising, managing stress and taking medications to lower blood pressure and cholesterol.

But if 70% of patients took part in cardiac rehab, 25,000 lives could be saved and 180,000 hospitalizations prevented each year, according to the Million Hearts Cardiac Rehabilitation Collaborative, sponsored by the U.S. Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services.

"Behavior change is really tough," Whooley said. People are very motivated when they're in the hospital and they're sitting in a bed and thinking I never want to have a heart attack again. But then they go back home and it's pretty hard to get motivated to get out there and exercise, eat healthy and take good care of yourself."

At-home cardiac rehabilitation programs can be particularly effective, Whooley said.

"They can end up with more lasting effects because people integrate the behavior changes into their regular life instead of coming to the hospital and practicing something and thinking they're cured and going home," she explained. "The whole point is you need to change your lifestyle."

For the new study, Whooley and her colleagues collected data on more than 1,100 veterans who were eligible for cardiac rehabilitation at the San Francisco VA Medical Center between August 2013 and December 2018. In all, 490 patients took part in the home rehabilitation program.

During the 12 weeks of the program, participants received up to nine coaching calls, motivational interviews, a workbook and a health journal to keep track of vital signs, exercise and diet. They also received a blood pressure monitor, a scale and a stationary bike. A nurse or exercise physiologist worked with patients to create physical activity goals. Participants were followed for an average of four years after hospitalization.

The study found that 4% of those who did not participate in the rehab program died within a year after hospitalization, compared with 2% of those in the home rehab program.

Over the four years of follow-up, 12% of rehabilitation patients died versus 20% of those who weren't in the program, the researchers found.

The findings were published March 1 in the Journal of the American Heart Association.

Two heart experts not involved with the study acknowledge the importance of rehabilitation after a heart attack.

However, one barrier to home rehab is the lack of insurance coverage, said Dr. Benjamin Hirsh, director of preventive cardiology at North Shore University Hospital in Manhasset, N.Y.

A bill before U.S. Congress that would approve coverage for home cardiac rehabilitation for Medicare and Medicaid patients, but whether it will pass is still up in the air, Hirsh said. If it does, it is likely that private insurers will follow suit.

"Cardiac rehab is important because we know it improves quality of life and reduces the number of times patients come back for stents or have heart attacks and increases their longevity," Hirsh said.

"You should be enrolling in a cardiac rehab program whether it's through the hospital or through virtual programming," he said. "It's available, it's out there, so if you seek it you will find it."

This is a landmark study on home-based cardiac rehabilitation and its effect on death rates, said Dr. Randal Thomas, a professor of medicine at the Mayo Clinic Alix School of Medicine in Rochester, Minn.

"Its results will help strengthen the case for home-based cardiac rehabilitation as Medicare and other insurance carriers continue to decide on how they will cover these important services," he said.

Many eligible people don’t receive cardiac rehabilitation due to various barriers, including other time demands, travel and lack of insurance. Also, many doctors fail to refer patients and some health systems don't have home rehab programs. Insurance co-pays can also be a significant barrier, Thomas said.

"All patients should be encouraged to participate in a cardiac rehabilitation program if they have had a heart attack, heart stent placement, heart surgery, or if they have ongoing heart pain," Thomas said. "On average, it will help them feel better, do better and live longer."

Sources

• Mary Whooley, MD, professor, medicine, epidemiology and biostatistics, University of California, San Francisco
• Randal Thomas, MD, professor, medicine, Mayo Clinic Alix School of Medicine, Rochester, Minn.
• Benjamin Hirsh, MD, director, preventative cardiology, North Shore University Hospital, Manhasset, N.Y.
• Journal of the American Heart Association, March 1, 2023, online