More cardiac rehab reduces death for elderly heart patients

December 21, 2009

Medicare beneficiaries with heart disease who attended more cardiac rehabilitation sessions had fewer heart attacks and were less likely to die within four years than those who went to rehab less, researchers report in Circulation: Journal of the American Heart Association.

Researchers analyzed data from 5 percent of the nation's Medicare beneficiaries that included more than 30,000 patients age 65 and older who had gone to at least one cardiac rehabilitation session between the 2000 and 2005. When examining those who went to cardiac rehab, investigators learned: The more sessions, the better.

"We were not surprised that patients who attended more rehabilitation had better outcomes," said Bradley G. Hammill, M.S., lead author of the study. "We need to encourage physicians to recommend cardiac rehabilitation to eligible patients, and we need to encourage those patients to attend and stay with it."

Medicare reimburses 36 sessions, yet about half of these Medicare-enrolled patients attended 24 or fewer, said Hammill, senior biostatistician at the Center for Clinical and Genetic Economics at Duke Clinical Research Institute in Durham, N.C.

Researchers found:Hammill and his colleagues conducted the study to determine if there was a best "dose" of cardiac rehab that would help patients the most.

Typically, people attend cardiac rehab two to three times per week for six to eight weeks, he said. The program is designed to fit each patient's abilities and needs and typically includes counseling about cardiovascular disease, nutrition, reducing stress, how to properly use medications and any emotional concerns. A physician supervises an exercise plan, and a rehab program can also include:Patients are usually referred to a cardiac rehabilitation facility after a heart attack, coronary bypass surgery, heart transplant or other cardiac interventions. Rehab is also used for the long-term management of angina, which is chest pain caused by clogged or narrowed arteries.

"Unfortunately, use of cardiac rehab is very low," Hammill said. "Under 20 percent of those eligible ever go and women and minorities go less often than white men. We need to promote cardiac rehab for everyone."

Hammill said he will continue studying the use of cardiac rehab.

"An important point about cardiac rehabilitation is that each visit involves interaction with a healthcare provider," he said. "And there is benefit to having contact with the medical system."
-end-
Co-authors are: Lesley H. Curtis, Ph.D.; Kevin A. Schulman, M.D.; and David J. Whellan, M.D., M.H.S. Author disclosures are on the manuscript.

This study was funded by grants from the National Institute on Aging and the National Heart, Lung, and Blood Institute.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

NR09 - 1180 (Circ/Hammill)

American Heart Association

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