Milwaukee Journal Sentinel
MILWAUKEE - In an era of modern heart medicines, the old standby of cardiac rehabilitation has become somewhat passe in the eyes of at least a few in the medical and health insurance communities, doctors say.
Medicare and insurance company funding for rehab has been limited, and new medicines such as cholesterol-lowering statins seem to have diminished its importance since the 1980s, when many heart attack patients were enrolled in cardiac rehab programs.
However, a new study suggests that cardiac rehab is just as crucial today as it was 20 years ago.
Patients who did not participate in a cardiac rehab program after having a heart attack were 48 percent more likely to die in the following three years than those who did participate, according a long-term Mayo Clinic study of 1,821 Minnesota residents.
For those who took part in cardiac rehab, survival was about the same as for people of the same age and sex who never had suffered a heart attack, said lead author Veronique Roger, a Mayo Clinic cardiologist.
"It led to a large improvement in survival in those who participated," she said.
The study also found that women were 55 percent less likely to participate in cardiac rehab than men, and people older than 70 were 77 percent less likely to participate than people younger than 60. The study included 765 women and 1,056 men, and nearly half of the study participants were older than 70.
The study, published in the September issue of the Journal of the American College of Cardiology, looked at cardiac rehab participation and outcomes between 1982 and 1998.
Cardiac rehab is a medically supervised, holistic program that provides initial therapy to patients after heart attacks, bypass surgery or angioplasty. It helps patients regain strength and educates them about exercise, diet, smoking, stress relief and other healthy lifestyle measures. Such programs also counsel people about taking the proper medications.
In an era of powerful new heart drugs, the study provides new evidence that cardiac rehab still can substantially improve survival, said Patrick McBride, a professor of cardiovascular and family medicine at the University of Wisconsin-Madison.
"This is a very critical study," said McBride, who served on a cardiac rehab advisory panel to the federal government in 1996.
However, several years ago the federal government denied coverage for patients who had angioplasty for heart disease, he said. And in 2003 the federal government began demanding that physicians be on site during rehab sessions, which typically are conducted by nurses or therapists, McBride said.
Ostensibly, the demand was because of the rare potential that someone might have a heart attack during a session, even though rehab nurses are trained in CPR, he said.
"They do not demand this type of coverage in intensive care units," McBride said. "Many rehab programs around the country are closing due to these restrictions."
About a year ago, St. Luke's Medical Center got into trouble with Medicare and was required to repay $45,000 it had billed for cardiac rehab services to 22 patients who had undergone angioplasty, said Sandy Zemke, a nurse and supervisor of the cardiac rehab programs at St. Luke's.
Kiran Sagar, a cardiologist at St. Luke's, said she was pleased to see the new study.
"The study definitely shows it (rehab) reduces deaths," she said. "It also reduces the incidence of recurrent heart attacks."
She noted that people who take part in rehab are more likely to comply with the changes that need to be made in their life.
If anything, cardiac rehab is more important today, said Byung-il Choi, a professor of medicine at the Medical College of Wisconsin who also works in cardiac rehab at Froedtert Memorial Lutheran Hospital in Milwaukee.
That's because more people are not only surviving heart attacks but also surviving with more of their heart muscle preserved.
"Now we have a huge volume of people who can participate," he said.
He said the new study should help convince doctors of the importance of cardiac rehab.
(c) 2004, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.