1. Potera, Carol


Providers need to 'sell' it to patients.


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Cardiac rehabilitation lowers the risk of death from future heart problems by as much as a third, and yet surprisingly few people participate in such programs after a myocardial infarction or coronary artery bypass grafting (CABG) surgery. So shows an examination of Medicare claims of 267,427 men and women age 65 or older who were hospitalized in 1997 for myocardial infarction or CABG surgery.


Researchers found that in the year after discharge, fewer than 14% of patients who had had a myocardial infarction and 31% who'd had CABG surgery participated in cardiac rehabilitation programs. Even though Medicare pays for such services, men participated more often than women and younger people more often than older ones; twice as many whites as nonwhites took part.


There were also dramatic geographic differences: 6.6% of eligible patients in Idaho participated, compared with 53.5% in Nebraska. High participation in Midwestern states may have been due to training and attitudes of health professionals in that part of the country, as well as standardized procedures for referring patients to cardiac rehabilitation.


Cardiac rehabilitation entails supervised exercise to improve cardiovascular fitness, nutritional counseling, help in managing chronic conditions, and interventions to quit smoking. Nurses and exercise specialists provide the vast majority of care. "Nurses are absolutely crucial in influencing patients to participate in cardiac rehabilitation and keeping lifestyle modification programs on track," says cardiologist William Stason, a study coauthor. "In my experience, nurses are the people who most influence patient behavior."


In an accompanying editorial, Randal Thomas, director of the Cardiovascular Health Clinic at the Mayo Clinic, calls the study "a wake-up call to all providers of cardiovascular health care to find solutions to this problem." Cardiac rehabilitation services could be improved by educating both patients and providers on the benefits of programs, setting up automatic referrals to simplify enrollment, and increasing rates for third-party payers or linking reimbursement to participation in cardiac rehabilitation programs. According to the editorial, not even 19% of eligible Medicare patients took advantage of the life-saving programs in 1997. If all states increased their rate to that of Nebraska, 93,000 more Medicare patients would receive cardiac rehabilitation, and cardiac deaths would decline. Improving services "will depend on nurses," says Thomas.

Figure. Michael McCa... - Click to enlarge in new windowFigure. Michael McCall, left, talks with Karen Buri at North Kansas City Hospital in North Kansas City, MO. Patients can take exercise classes and receive counseling on how to reduce their risk factors for heart attacks and other cardiovascular diseases.

Carol Potera


Suaya JA, et al. Circulation 2007;116(15):1653-62; Thomas RJ. Circulation 2007;116:1644-6.