By Lisa Rapaport
Heart attack survivors who participate in cardiac rehabilitation programs may survive longer and be less likely to have repeat hospitalizations than they would without follow-up care, a recent study suggests
Previous research has linked medically supervised cardiac rehab programs focused on things like stress reduction, exercise and heart healthy living to lower mortality rates. The current study offers fresh evidence of this: rehab program participants were 42 percent less likely to return to the hospital or die within five years of discharge than people who didn’t do rehab.
“Survival rates after a (heart attack) have improved in the last three decades,” said study co-author Enrico Fabris of the University of Trieste in Italy.
While much of this improvement is due to wider availability of newer and more effective surgeries to restore blood flow after a heart attack, rehab programs also play a crucial role in preventing or slowing the progression of heart disease and helping to ward off another heart attack, Fabris said by email.
For the study, researchers examined data on 839 patients discharged from hospital cardiovascular care units with planned cardiac rehab and 411 patients sent home without any rehab plans.
All of the patients were treated in the hospital between 2009 and 2010 after heart attacks or a procedure to restore blood flow to the heart. Most participants were men, and they were typically in their late 60s at the start of the study.
Many of them had chronic health problems like high blood pressure and diabetes
After following most participants for at least 5.6 years, researchers found that 6 percent died in both the rehab group and in the comparison group of people who didn’t receive rehab.
With rehab, however, only 15 percent of patients returned to the hospital compared with 27 percent of those who didn’t receive rehab, according to the results in the European Heart Journal.
In a separate analysis to estimate the effect of treatment, researchers calculated that with rehab, just 10 percent of patients would die from all causes, compared with 19 percent of patients without rehab. Deaths from cardiovascular causes would also be lower with rehab: 2 percent with rehab compared to 7 percent without it.
The study wasn’t designed to prove whether or how rehab might directly impact repeat hospitalizations or deaths. Researchers also lacked data on how faithfully patients took medicines prescribed to help prevent another heart attack or blockage in their blood vessels.
Even so, the results add to evidence pointing to the long-term benefits of cardiac rehab, said Dr. Hani Jneid of Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston.
“This long-term improvement in cardiovascular outcomes – observed after a median follow-up of 6.8 years – was driven predominantly by a lower rate of cardiovascular hospitalizations,” Jneid, who wasn’t involved in the study, said by email.
“But most remarkable is that after analyses (to estimate the effect of treatment), there was also a significant reduction in total and cardiovascular mortality associated with the use of cardiac rehab,” Jneid added
Ideally, every patient hospitalized for a heart attack should do cardiac rehab and get as much exercise as possible, said Dr. Chip Lavie, of the Ochsner Clinical School-University of Queensland School of Medicine in Australia.
“For those who do cardiac rehab, which is currently in the U.S. 3 times weekly for 12 weeks, we still want them to exercise 2 to 3 times weekly outside the program and to continue exercise after the cardiac rehab program,” Lavie, who wasn’t involved in the study, said by email. “For those who do not attend for whatever reason, home exercise should still be of substantial benefit.”
SOURCE: European Heart Journal, online July 27, 2018
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