Thursday, November 15, 2007

Cardiac Rehab - Proven but Underused

Cardiac rehabilitation for patients who have had a heart attack or procedure is proven to reduce new cardiovascular complications just as well as medication. Published guidelines since 1995 have recommended a comprehensive approach to cardiac rehab, including exercise training and lifestyle interventions. Despite this benefit, less than 30% of eligible patients are referred to cardiac rehab programs by their doctors. Under 14% of patients over age 65 who have had a heart attack have rehab. What is going on?

Somehow, physician awareness lags behind the evidence. Marjorie King, MD, the coauthor of the cardiovascular performance guidelines published this month in Circulation was quoted in JAMA : "The biggest factor is that physicians just plain don't think about it-we're detailed by drug companies all the time; we're not detailed by rehab clinics. It's just not part of the algorithm for treatment."
("Detailing" is when drug reps pitch their drug to doctors)

Other barriers to patients getting needed cardiac rehabilitation are that Medicare only pays about $20 per session so hospitals aren't eager to offer or expand this service. It is good for patients and good for public relations, but they can't break even on it.

Researchers found that these are the patients that would benefit from cardiac rehabilitation:
  • Acute Myocardial Infarction (heart attack)
  • Coronary Artery Bypass
  • Heart valve or heart transplantation surgery
  • Stent placement or any coronary intervention
The recent findings of low usage should act as a wake up call for clinicians as well as create awareness of the need for rehab by patients who have had a coronary event.

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