By AMERICAN HEART ASSOCIATION NEWS
Cardiac rehabilitation programs can boost independence and quality of life for older adults, especially after hospitalization for heart disease, but it’s not always prescribed, according to a scientific statement published Thursday by the American Heart Association.
Cardiac rehabilitation provides exercise training, advice for handling stress and depression, improved eating and smoking cessation. However, only about one-third or fewer eligible elderly cardiac patients get such care. Improving strength, balance and overall physical function can help patients have the confidence to live independently, said Forman.
Despite the benefits, doctors often fail to recommend cardiac rehab, he said.
“Cardiac rehabilitation is not prescribed often enough,” Forman said in a news release. “When treating cardiac patients in their 70s, 80s and 90s, healthcare providers often stress medications and procedures without considering the importance of getting patients back on their feet, which is exactly what cardiac rehabilitation programs are designed to do.”
Many doctors don’t think it’s their job to refer patients and getting more patients into rehab will take more education and even financial incentives, said Forman.
“The surgeon, cardiologist, primary care doc, nutritionist, physician therapist, nurse and hospitalist should all be emphasizing cardiac rehabilitation,” he said.
The need for cardiac rehabilitation is growing as the number of Americans 65 or older is expected to double between 2010 and 2050, according to the statement.
Despite the health benefits of medication treating heart disease risk factors, some drugs can lead to side effects like muscle pain, fatigue, dehydration and dizziness, which may discourage physical activity, Forman said.
“By the time they’re 75, about half of cardiac patients are taking more than 10 medications, and they can have cumulative effects that are uncertain and which can be debilitating,” according to Forman.
But medication adjustments can be made to enhance physical activity.
“Cardiac rehabilitation provides a superb opportunity to consider these types of therapeutic modifications,” Forman said.
“Many people are anxious after a hospitalization,” said Daniel E. Forman, M.D., a geriatric cardiologist who chaired the panel writing the statement.
“Cardiac rehabilitation provides a path towards activity and support. It provides answers to questions regarding diseases, medications, and other concerns,” he said.
Cardiac rehab can benefit patients who are relatively fit, as well as older patients with complex health issues, even if they think rehab is not for them, said Forman, a professor of medicine at the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System in Pennsylvania.
Physical activity helps improve the loss of strength and balance caused by aging, and can reduce frailty that affects older heart patients, according to the statement.
Wilma Lewis, 82, of Plano, Texas, waited a few months after being released from the hospital before calling about cardiac rehabilitation following her heart attack five years ago.
“A lot of people think, ‘I don’t need the rehab, I can do this on my own.’ I found that on my own I didn’t do it like it should be done,” Lewis said.
Lewis walked on a treadmill two to three days a week, gradually increasing her distance. She rode a stationary bike and did strengthening exercises. She also learned to limit the amount of salt she was eating.
Having nurses nearby while she was exercising, and talking with others in cardiac rehab was a comfort, Lewis said.
“They had two to three nurses there all the time, and if you got so you didn’t feel well, they were always there to check you and knew what to do,” she said. Chatting with others in rehab helped her realize she wasn’t the only one having heart problems, she said.
For Lewis, the biggest challenge of cardiac rehabilitation was having to get up and get going. Having a regular schedule of rehabilitation visits helped her “do it and do it right,” as did knowing her insurance was covering the costs.
Medicare covers cardiovascular rehabilitation after a heart attack or hospitalization for heart failure after deductibles are met. Patients pay a portion of the charges or a co-pay to the outpatient facility.
“I probably wouldn’t have paid out of pocket, because I am on a fixed income,” she said.
“Sometimes you just can’t afford it, and if you don’t have insurance you are out of luck.”
Despite completing rehab after her heart attack, Lewis did not return after open heart surgery to repair heart valve repairs two years later. Instead, she did limited exercise with a visiting home healthcare specialist, she said.
“I haven’t kept up with it very well, I’ll admit. Every ounce of my weight loves me,” Lewis said.
Even without a formal cardiac rehabilitation program, doctors can tailor physical activity advice to help patients remain independent, according to the statement. This might include daily walking, tai chi or yoga, or even doing more chores around the house, Forman said.
To stay on top of patients’ strength, physical and cognitive abilities before and after medical procedures and hospitalizations, the statement details the tests doctors can regularly use.
“If you don’t move, you don’t get any stronger, so be sure that you move some,” Lewis said. “Try to do what the doctor tells you and take care of yourself.”