Heart patients should consider cardiac rehabilitation
Heart patients should consider cardiac rehabilitation
(Reuters Health) - Patients who have had a heart attack, stent placement or bypass surgery should seriously consider enrolling in a cardiac rehabilitation program, say the authors of a new resource for patients published in JAMA Cardiology.
These programs focus on nutrition, stress management, exercise, psychological support, smoking cessation and education about heart disease. Not only do they help the heart to recover, but they can also relieve anxiety, reduce risk factors and improve quality of life, the authors write.
"There are short and long term benefits to participate, including less chest pain, less depression and a lower risk of death from heart disease," said Dr. Tamara Horwich, of the University of California at Los Angeles, who authored the first manual of a page for patients.
Horwich, who is medical director of UCLA's cardiac rehabilitation program, emphasizes the importance of lifestyle changes to prevent and reverse heart disease. She encourages patients to enroll in heart recovery programs for group support and guidance supervised by a doctor.
"I tell my patients that if we work together, this heart problem does not have to happen again," he told Reuters Health by telephone. "By taking the right medications and living a healthy lifestyle, repeating heart attacks will not be a problem."
Available for free, the new patient page (bit.ly/2ORMLnz) offers practical advice on how to join cardiac rehabilitation programs.
"Unfortunately, patients who wish to participate may face barriers such as insurance, transportation or time in their schedules," Horwich said. "We have to work on addressing this."
Horwich and his co-author, Dr. Gregg Fonarow, who is co-head of UCLA's cardiology division and co-director of his preventive cardiology program, first explains the goals of cardiac rehabilitation to stop or reverse the progression of the heart disease. Aerobic training is often the cornerstone of these programs, but other key components focus on nutritional counseling and education on topics related to the heart, such as blood pressure, diabetes and cholesterol.
Typically, cardiac rehabilitation programs, which are based in a hospital or doctor's office, can include two or three sessions of one hour per week for 12 to 18 weeks, with a total of approximately 36 hours. Intensive programs can continue up to 72 hours.
"When you have a heart attack or undergo a bypass or stenting, it's a life-changing and often terrifying experience," said Dr. Nieca Goldberg, medical director of the Women's Heart Program. the New York University Langone Health in New York City.
"Many times, these patients did not exercise, were stressed and did not know how to start or organize themselves to take care of several aspects of their heart health," said Goldberg, who was not involved in the patient's appeal.
The American Heart Association and the American College of Cardiology strongly recommend enrolling in these programs. According to the AHA, patients who take their medications and complete a cardiac rehabilitation program may reduce their risk of hospital readmission and cardiovascular death. In addition, exercise capacity is likely to increase, and cholesterol, blood pressure, and blood sugar levels should decrease.
"These programs have been recommended for a long time because they really improve the quality of life for patients," Goldberg said in a telephone interview. "In my practice, we always mention cardiac rehabilitation with patients."
The new studies are looking for ways to create remote or home-based cardiac programs by using smart watches or monitors to analyze heart rate, blood pressure and heart rate. Then, patients can participate in group videos online from the comfort of their homes.
"We are developing the program now and we have the technology in place, so it's a matter of getting the details of the program established," Horwich said. "In addition, there are barriers to payment and insurance reimbursement for online programs, so we are also working on that."
After a cardiac rehabilitation program, it is important that patients and doctors create a plan for what will happen after graduation, Goldberg said. By creating a plan and registering, patients are more likely to follow the changes in lifestyle they have learned and continue exercising, eating well and managing their stress.
"It's a process that lasts a lifetime," he said. "It's not just about keeping patients out of the hospital, it's about healthy lifestyle choices that last."
SOURCE: bit.ly/2ORMLnz JAMA Cardiology, online October 10, 2018.
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