Study: Care after heart trouble is vital

If you've had a heart attack or a bypass operation, there's an easy way to help prevent another one: stick with rehab.

People who get all 36 sessions of cardiac rehabilitation that most Medicare plans cover are less likely to die or suffer a heart attack in the next three to four years than people who have fewer sessions, a new study finds.

The research could encourage the multitudes of heart patients who don't follow doctors' orders to heed their advice. Only about one-fifth of heart patients even try rehab. Of those who do, few get all the recommended sessions.

The new study is one of the first big efforts to look at how survival is affected by the "dose" of rehab that heart patients get. Researchers saw a clear trend in this 65-and-older group.

"What this study shows in a very convincing manner is that the more sessions a cardiac patient goes to, the better off they are," said Stanley Hazen, preventive cardiology and rehabilitation chief at the Cleveland Clinic.

He had no role in the study, which was led by Duke University scientists and published online yesterday in Circulation, an American Heart Association journal. Federal grants paid for the work.

Say "rehab" and many people envision weak heart patients being pushed to run on a treadmill. Exercise is crucial, but "they don't need to be grimacing and jogging around the track," Hazen said. "It can be just a brisk walk or swimming or a stationary bike. That's the key: Find something you enjoy and are willing to do."

To be covered by Medicare, rehab also must include lifestyle counseling - nutrition advice, weight management, help to stop smoking, even cooking classes and pointers on reducing stress, said the study's leader, Duke biostatistician Bradley Hammill.

Many patients find they enjoy the counseling, he said. .

"After you've been hospitalized and somebody then talks to you about these lifestyle changes, it might be more likely to sink in. It's the teachable moment," Hammill said.

His study used records on more than 30,000 Medicare recipients who went for at least one rehab session after being hospitalized for a heart attack, a bypass operation, or chronic and severe chest pain due to clogged arteries.

More than three years later, 18 percent of those who attended fewer than 12 cardiac rehab sessions had died versus 11 percent of those who went to all 36 sessions. After taking into account age and other differences in these groups of patients, that works out to a 47 percent reduction in the risk of death for those attending 36 sessions. Heart attacks also were less common in that group.