Rehab after heart attack
tied to longer, not healthier life
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[October 22, 2016]
By Lisa Rapaport
(Reuters Health) - Heart attack survivors who participate in cardiac
rehabilitation programs may survive longer, but feel no healthier, than
they would without this follow-up care, a U.S. study suggests.
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Previous research has linked medically supervised rehab programs
focused on things like stress reduction, exercise and heart healthy
living to lower mortality rates. The current study offered more
evidence of this: rehab participants were 41 percent less likely to
die of all causes during up to seven years of follow-up.
But in the first year after a heart attack, patients who went
through cardiac rehab had health improvements similar to the group
that didn’t, the current study also found.
“Despite no difference in health status noted in our study, patients
who have suffered an acute myocardial infarction (heart attack)
should continue to be referred and strongly encouraged to
participate in comprehensive cardiac rehabilitation, given its
association with increased survival,” said lead study author Dr.
Faraz Kureshi of the University of Missouri Kansas City School of
Medicine.
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Kureshi and colleagues examined data on 2,015 heart attack survivors
who went through one of these programs and another similar group of
2,914 survivors who didn’t.
At the start of the study, patients were 60 years old on average.
Compared with those who didn’t participate in rehab, those who did
were more likely to be male, white, married, employed full-time and
have health insurance with coverage for medications, researchers
report in JAMA Cardiology.
Patients who did cardiac rehab were also less likely to avoid
seeking health care due to costs, have a history of prior heart
attacks or a history of smoking. They were also healthier.
When patients were asked to rate their quality of life, treatment
satisfaction and frequency of chest pain, there wasn’t much
difference between the group that did rehab and the group that
didn’t.
With rehab, however, patients did report a small but statistically
meaningful difference in physical limitations.
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The results underscore a lack of evidence to support the
recommendation of cardiac rehab to help people feel healthier after
a heart attack, the authors conclude.
Limitations of the study include the reliance on patients to
accurately recall and report whether they participated in rehab and
what improvements they may have experienced in health outcomes, the
authors note.
It’s possible, too, that it’s a stretch to attribute longer survival
times to cardiac rehab since people were counted as participants in
this group if they did even a single session, Dr. Hani Jneid of
Baylor College of Medicine in Houston wrote in an accompanying
editorial.
Still these programs are safe and cost-effective and the study
results suggest doctors could refer patients for rehab more often
than they do now, Jneid wrote.
“Irrespective of the neutral effects on health status observed in
the current report, the benefits of exercise-based cardiac rehab
have been extensively demonstrated,” Jneid said by email.
“Besides conditioning and increasing physical activity in a
monitored and safe fashion, it has numerous direct health benefits,”
Jneid added. “These include weight reduction, and improvement in
lipid levels, blood pressure, and other risk factors.”
SOURCE:
http://jamanetwork.com/journals/ jamacardiology/fullarticle/2569804
JAMA Cardiology, online October 19, 2016.
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