Cardiac Rehab: What Works, and for How Long
Should cardiac rehab be standard for patients who've had a heart attack. If so, how long should it last? A Dutch study found a year was about right.
After a heart attack, whether patients in the US get extensive rehabilitation depends on insurance coverage.
Reporting today at the European Society of Cardiology’s ESC Congress 2016 in Rome, Italy, researchers from the Netherlands said such programs are common in Europe, and that the longer patients get the rehab, the better they do in terms of being happier, fitter, and less anxious.
But that did not include cardiovascular risk score improvement.
Such rehab programs are also subject to the vagaries of human nature, seen in drop out rates.
In a study called OPTICARE, Ron van Domburg, PhD said enhanced rehab programs that lasted a year showed that patients were “happier, healthier, and more active” than those in the shorter programs.
But, he added, 40% of patients drop out of the shorter 3-month standard program, and another 25% dropped out when it was extended to 12 months.
The rehab study involved 914 patients with acute coronary syndrome.
They were randomized to rehab programs that varied in turns of how much exercise, education, fitness training, and personal telephone coaching they offered.
Measured at 18 months, the primary outcome did not show improved cardiovascular risk score improvement over the shortest three-month program.
The most motivated patients did have higher rates of smoking cessation and lower cholesterol levels.
Commenting on the findings in an interview, Jeffrey Kuvin, MD, Chief of Cardiovascular Medicine at Dartmouth Hitchcock in Lebanon, NH, said that while American College of Cardiology guidelines do call for cardiac rehab, insurers vary in their willingness to pay for them, and in the length of time the programs take.
In his own practice he has seen the programs work, he added. “Longer is definitely better, though patients do drop out.”
One of the most interesting findings, he said, is that patients who get through the rehab have far less anxiety about their having had a heart attack. “It’s something we don’t always realize but these patients experience a lot of stress and anxiety after they recover,” he said.
