Many heart patients not getting rehab despite the benefits

Cardiac rehabilitation programs can boost independence and quality of life for older adults, especially after hospitalization for heart disease, but it’s not always prescribed, according to a scientific statement published last week by the American Heart Association.

Cardiac rehabilitation provides exercise training, advice for handling stress and depression, improved eating and smoking cessation. However, only about one-third or fewer eligible elderly cardiac patients get such care.

Improving strength, balance and overall physical function can help patients have the confidence to live independently, Dr. Daniel E. Forman, a geriatric cardiologist who chaired the panel writing the statement, said.

Despite the benefits, doctors often fail to recommend cardiac rehab, he said.

“Cardiac rehabilitation is not prescribed often enough,” Forman said in a news release. “When treating cardiac patients in their 70s, 80s and 90s, health care providers often stress medications and procedures without considering the importance of getting patients back on their feet, which is exactly what cardiac rehabilitation programs are designed to do.”

Many doctors don’t think it’s their job to refer patients and getting more patients into rehab will take more education and even financial incentives, said Forman.

“The surgeon, cardiologist, primary care doc, nutritionist, physician therapist, nurse and hospitalist should all be emphasizing cardiac rehabilitation,” he said.

The need for cardiac rehabilitation is growing as the number of Americans 65 or older is expected to double between 2010 and 2050, according to the statement.

Despite the health benefits of medication treating heart disease risk factors, some drugs can lead to side effects like muscle pain, fatigue, dehydration and dizziness, which may discourage physical activity, Forman said.

“By the time they’re 75, about half of cardiac patients are taking more than 10 medications, and they can have cumulative effects that are uncertain and which can be debilitating,” Forman said.

But medication adjustments can be made to enhance physical activity.

“Cardiac rehabilitation provides a superb opportunity to consider these types of therapeutic modifications,” Forman said.

“Many people are anxious after a hospitalization,” Forman said.

“Cardiac rehabilitation provides a path towards activity and support. It provides answers to questions regarding diseases, medications, and other concerns,” he said.

Cardiac rehab can benefit patients who are relatively fit, as well as older patients with complex health issues, even if they think rehab is not for them, said Forman, a professor of medicine at the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System in Pennsylvania.