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Cardiac rehab a Lifesaver after angioplasty.

You may want to think twice if you're forgoing cardiac rehabilitation after angioplasty. .A new study published online May 16 in Circulation finds that patients who take part in cardiac rehab after angioplasty significantly boost their chances of staying alive.

"I'm not at all surprised at this," says Bruce Darrow, MD, Medical Director of Telemetry Services at Mount Sinai. "This is something previously demonstrated, but it's a welcome extension and more evidence for a practice that already had a lot going for it."

Rehab benefits Researchers looked at almost 2,400 patients who underwent angioplasty. The procedure opens arteries using a tiny balloon that flattens plaque against the vessel wall. Physicians often insert a small mesh tube called a scent to keep the vessel open.

The 14-year study showed a 46 percent reduction in death from all causes among the patients, who participated in an average of 13.5 sessions of cardiac rehab after angioplasty. Dr. Darrow says the success is due to the overall effect of cardiac rehab on the cardiovascular system. "It allows you to work more efficiently and allows the body to extract more oxygen and achieve a higher work load," Dr. Darrow says. "It enables you to walk a greater distance at a lower heart rate and thus get more mileage out of the work the heart does do."

How rehab works Cardiac rehab provides medically supervised education, counseling and physical fitness training. At Mount Sinai, the program typically lasts 12 weeks, with sessions two to three times per week. It starts by establishing baselines.


"When patients come, prior to their first visit, they undergo a non-threatening stress test. They walk on a treadmill to see what they can do. That gives us a baseline," says Dr. Darrow. "Then a therapist sets goals for how far they walk, heart rate response and blood pressure response."

As well as monitored exercise programs, patients receive counseling on diet, nutrition, medication adherence and smoking cessation if they need it. Dr. Darrow says the hope is that patients will continue the program for the long haul. "The things that help them live longer are those systematic changes that not only help the areas that are blocked but the whole heart, because they essentially stabilize the whole network," he notes.

Rehab underutilization Despite the positive results of cardiac rehab, Dr. Darrow says at least 30 percent of his patients don't take part in the conditioning when he recommends it. "Half choose not to go, perhaps because they're taking care of family members, or they work. The other half don't go because there's something that stands between them and rehab, whether it's distance or an inability to take part physically," explains Dr. Darrow.

Nationally the number of patients who don't take part is much higher, with only about 50 percent of patients who are referred attending. What's more, doctors refer only 50 percent of the high-risk patients who could benefit. Dr. Darrow says some physicians may not know about the benefits of rehab, and some are at hospitals that don't offer it. But a patient's limitations also factor in. "You look at a person who is bed-bound or sick from other health problems and you say that person will never be able to do cardiac rehab," says Dr. Darrow, "so it's not appropriate to refer those patients."

Still, Dr. Darrow is hopeful that the value of cardiac rehab will make it a standard of care for eligible patients who are hospitalized with common heart conditions. He predicts that it will become automatic to send out referrals for rehab along with aspirin therapy, and he thinks patients will be grateful for that. He sees the difference cardiac rehab makes for his own patients. "They love it," he says, "and they don't want it to end."


* Cardiac rehab is prescribed for patients recovering from angioplasty, bypass surgery, heart attack and also for patients with a wide range of conditions, including congestive heart failure and angina.

* Patients with severe heart disease who are unable to exercise may still benefit from the other cardiac rehab services, such as nutrition and smoking cessation counseling.

* More than 600,000 angioplasties are performed in the United States each year, according to the American Heart Association.
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Publication:Focus on Healthy Aging
Article Type:Clinical report
Date:Aug 1, 2011
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