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Cardiac rehabilitation-the poor relation of treatment and prevention

Ami Banerjee
Last edited 17th March 2010

Coronary heart disease (CHD), which usually presents as a heart attack (or myocardial infarction, MI) is the most common cause of death and disability both in the UK and globally. The way in which CHD is treated and prevented therefore has huge implications for patients, health professionals and policymakers. Once a person has a heart attack, prevention of further heart attacks, stroke or death, or secondary prevention, is crucial. There is strong evidence for benefit of several drugs and treatments after heart attacks to this end, including aspirin, statins, ACE inhibitors and beta-blockers. Such treatments have undoubtedly saved lives, but studies in the US and the UK, have shown that between 30-60% of MI patients receive appropriate treatment. There are strong arguments for giving more people the right drugs with benefits in terms of mortality and cost-effectiveness. Current NICE guidelines therefore recommend these treatments for all patients following a heart attack.

This week, the British Heart Foundation reported that only 38% of such patients were receiving adequate rehabilitation care. “Cardiac rehab includes advice from dieticians, physiotherapists and psychologists about how to live with the consequences and improve the survival chances following heart attacks, coronary artery bypass operations and angioplasties.” The components of cardiac rehab have benefits individually and together. For example, a review of 46 trials including 9000 patients showed that exercise-based rehabilitation reduces all deaths by 20%, and cardiac deaths by 26%. Some patients are too ill to benefit from cardiac rehabilitation, and others choose not to partake or continue with the rehabilitation programme.

Provision of drug treatment and primary angioplasty programmes has improved more than cardiac rehabilitation, which has remained the poor relation. This is partly because we tend to favour treatment rather than prevention, and pills rather than behaviour changes. To a greater extent than other treatments, cardiac rehabilitation needs the commitment of the patient. However, this does not mean that we cannot be innovative in designing ways of increasing access to this vital aspect of care for patients after MI.

Seven Out Of 10 Eligible

Seven Out Of 10 Eligible Patients Not Given Cardiac Rehabilitation
http://bit.ly/I0ysW

seems the problem is getting worse

Cheers Carl

EBP for dummies

I am currently taking a graduate research class re: EBP in Physical Therapy. I am completely confused by the text, like it is a totally different language. Is there any good references that I could access to understand what inferences I can make from different statistical testing, design studies, ect....?

Thank you back!

Hi Danielle
Thanks for your message. I also had a look at your blog and you also have an interesting take on everyday health issues.

Exercise and lifestyle changes definitely put some of the responsibility back in the court of the patient, but we clinicans tend to favour hi-tech treatments over such measures, and so we are responsible too. For example, often smoking cessation advice and advice re. diet and exercise are ommited from consultations.

Best wishes
Ami

Thanks for an interesting post

I've enjoyed several of your posts. It is really valuable having a plain English take on what is going on in cardiology and medicine. I'm not a specialist, but I agree that there needs to be more of a stimulus for people to prevent further heart attacks in those at risk by taking responsibility for themselves and exercising. I'd love to see more government/policy initiatives to reward people who are physically active (e.g. tax deductions).

Danielle
http://healthinformaticist.wordpress.com/

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