eCardioVascular Beat

Why cardiac rehab? The numbers explain

Suzanne Hall, M.D., F.A.C.C.

Medical director, Providence Cardiac Rehabilitation Program
Cardiologist, Providence St. Vincent Heart Clinic-Cardiology

Cardiac rehabilitation and prevention programs were introduced in the 1960s and have expanded from in-hospital to outpatient programs. In 1995, cardiac rehab was included in clinical guidelines from the Agency for Health Policy and Research and the National Heart, Lung and Blood Institute as an essential component of contemporary care for patients with coronary heart disease.

Yet in the United States fewer than 30 percent of eligible patients participate in supervised programs.

Cardiac rehabilitation includes medical evaluation, prescribed monitored exercise, coronary risk-factor reduction and secondary prevention.

Exercise has been shown to:

• Prevent age-related endothelial dysfunction
• Reduce hemostatic factors such as fibrinogen, coagulation factors and viscosity
• Decrease C-reactive protein, or CRP
• Improve arterial compliance
• Restore ischemic preconditioning
• Improve flexibility, bone mass and endurance

Studies have shown that besides managing risk factors, cardiac rehabilitation significantly improves patients’ well-being while reducing stress and depression and improving return-to-work rates.

Meta analysis in 2005 included 21,295 patients involved in cardiac rehabilitation versus those undergoing usual care. The cardiac rehab group showed a significant decrease in recurrent MI (17 percent decrease at one year) and cardiac mortality (47 percent at two years).

In 2006, Centers for Medicare & Medicaid Services expanded coverage to include patients who have had PCI/CABG, a heart-lung transplant, an MI within the past 12 months, stable angina, or heart valve repair or replacement. Most third-party payers follow Medicare guidelines for coverage. Although American College of Cardiology and American Heart Association guidelines for heart failure recommend cardiac rehab, it is not a covered benefit of most insurers.

The cardiac rehabilitation program at Providence St. Vincent Medical Center began in August 2009 after five years of planning. By November of 2010, 250 patients had entered the program, which had an 83 percent compliance rate. These included 33 percent high-risk and 46 percent moderate-risk patients. Seventy percent of the program’s patients were men.

Physicians and patients have consistently given our cardiac rehab a 90 percent-or-better “excellent” rating for providing high-quality care.