Why thousands of Australians are missing out on vital rehabilitation programs
Brendan Trew felt strange when he walked into the cardiac rehab suite at his local hospital.
The 47-year-old patient considered himself healthy and was one of the youngest patients in the room.
“I went on a 37km bike ride and the next night I had a heart attack,” said the single father from Hampton, south-east of Melbourne.
But the six-week program, which included a combination of exercise, education and counseling, helped Trew regain his strength and, more importantly, reduced his risk of having another heart attack and dying.
A new landmark study has been published. International Journal of Cardiology, It found that participating in cardiac rehabilitation programs reduced patients’ risk of dying from another heart attack by 75 percent.
But the study of 7,100 Victorian patients across 13 public hospitals found only one in five eligible patients accessed these programmes.
Lead author Dr. from Monash University. Susie Cartledge suspects patients are skipping programs because advances in medical technology have minimized the severity of heart conditions.
“If you currently have a heart stent, it’s just a small wound in your radial artery,” Cartledge said, referring to the small incisions that replace many open-chest surgeries.
“Since the treatment is so minimally invasive, it actually minimizes any negative effects on the patient. They think, ‘I have a small scratch on my wrist that heals within a week, I should be fine.'”
But heart disease, which leads to blocked arteries and stent procedures, is something patients must manage for life, Cartledge said.
“We just can’t seem to get patients through the door,” he said. “If we can increase participation to just 60 percent, the healthcare system will experience huge financial savings and thousands of families will be spared the tragedy of a preventable second attack.”
He said shorter hospital stays after heart procedures meant patients were finding it overwhelming to process the information they were given at discharge. “We know that patients remember only about one-fifth of what we tell them in the hospital,” Cartledge said.
“Then they come back home, their sick leave ends, they go back to work and they fall back into their old habits, which is exactly what we don’t want.”
Patients participating in cardiac rehabilitation benefited from lower mortality and fewer unplanned readmissions. These health benefits increased with each additional session they attended.
“The mortality rate was four times higher in those who did not attend any sessions compared to those who attended the entire six-week programme,” he said.
A typical program in Australia lasts six to eight weeks and offers supervised cardio and strength training and education with health professionals. Counselors help patients process the emotional effects of having a heart attack and facing their own mortality.
Programs are carried out in public and private hospitals and through community health services.
Trew initially dismissed his chest pain as reflux. But when the pain intensified, he decided to go to Sandringham Hospital’s emergency department.
He was then taken by ambulance to The Alfred and told he had suffered a heart attack.
The news caused a shock. Trew had no risk factors for heart disease: He exercised regularly, ate reasonably well, and had normal blood pressure and cholesterol levels.
When he was discharged from hospital two days later, he felt vulnerable. He had a stent placed in his previously blocked coronary artery and was given medication to control his blood pressure and cholesterol.
“I became more aware of how fragile we all are,” she recalled.
A counselor in a cardiac rehabilitation program helped him overcome these feelings, while an occupational therapist identified strategies to help Trew return to his job in corporate sales.
He learned about nutrition in training and realized that he consumed too much salt.
Kegan Moneghetti, a cardiologist at St Vincent’s Health, said cardiac rehabilitation programs helped patients make behavioral changes that had the same clinical potency as pharmaceutical drugs. This includes changing diets, exercising and quitting smoking.
“These are usually free and just take our time and effort, but people need a structure and support system to achieve this,” Moneghetti said.
More funding is needed to ensure patients can access cardiac rehabilitation programs immediately after discharge from hospital, he said. Patients often face a six- to eight-week wait to access these programs, he said.
“There’s a small window where you can encourage people to participate in change,” he said.
Cardiovascular disease is one of Australia’s leading causes of death, claiming a life every 12 minutes, according to the Heart Foundation. Approximately one in six Australian adults are living with cardiovascular disease, which includes heart and blood vessel diseases such as coronary heart disease and stroke.
Most risk factors can be prevented by eating a healthy diet, exercising regularly and maintaining a healthy weight.
Start your day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.
