Many Heart Attack Patients Not Referred to Cardiac Rehab

MONDAY July 27, 2009 -- Even though cardiac rehabilitation has been shown to guard against future heart trouble once a cardiovascular event has landed someone in the hospital, only 56 percent of these patients are referred for the therapy, a new study finds.

Despite national guidelines that say hospitalized patients with a qualifying cardiovascular disease event should be referred to outpatient cardiac rehabilitation before hospital discharge, the study demonstrates this doesn't happen often enough, the researchers noted.

"Cardiac rehabilitation improves clinical outcomes, but is widely underutilized," said researcher Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles.

"A large number of patients hospitalized with coronary artery disease may be having recurrent cardiovascular events and deaths that could be prevented by greater participation in cardiac rehabilitation programs," he added.

The report is published in the July 28 online edition of the Journal of the American College of Cardiology.

For the study, Fonarow's team used data from the American Heart Association's Get With The Guidelines program to collect information on 72,817 patients discharged from hospitals after a heart attack, angioplasty or bypass surgery between January 2000 and September 2007.

The researchers found that only 40,974 (56 percent) of the patients were referred to cardiac rehabilitation when leaving the hospital.

Among those who had a heart attack, 53 percent were referred to rehab, as were 58 percent of patients who underwent angioplasty and 74 percent of those who had bypass surgery, the study found.

Among the 156 hospitals in the study, there was no consistency in referring patients to cardiac rehab. "These cardiac rehabilitation referral rates varied widely by hospital, ranging from as low as 0 percent of eligible patients referred, to as high as 100 percent of patients referred," Fonarow said.

In addition, older patients, those with a so-called non-ST-segment elevation heart attack and those with other medical conditions, such as lung disease, were less likely to be referred for cardiac rehabilitation, Fonarow's group noted.

"This is a missed opportunity to impact the care of these patients," study author Dr. Todd M. Brown, an assistant professor of medicine at the University of Alabama at Birmingham, said. "Physicians need to be educated about the importance of cardiac rehabilitation and emphasize to their patients the need to attend."

Fonarow thinks that new efforts are needed to get doctors to refer patients to cardiac rehab.

"Increased physician awareness regarding the clinical benefits of cardiac rehabilitation and new initiatives to overcome barriers to referral are critical to improve the quality of care and outcomes for patients with coronary artery disease," Fonarow said.

Dr. Byron Lee, an associate professor of cardiology at the University of California, San Francisco, says that cardiac rehabilitation can be just as effective in preventing another heart attack as the drugs these patients take.

"It is shameful how physicians underutilize cardiac rehabilitation in the United States," Lee said. "We emphasize expensive drugs and interventions, when a simple rehabilitation program can do just as much, if not more, to reduce the risk of death and recurrent heart attack," he said.

More information

For more information on cardiac rehabilitation, visit the American Heart Association.

Posted: July 2009


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