Jake Gray had always considered himself to be in pretty good shape. Having worked in North Carolina’s textile industry for much of his adult life, Gray was used to maneuvering heavy machinery on his own.
“I did all this stuff myself. I was hands-on — a one-man show.”
He stayed busy outside of work, too. “I’ve played golf all my life and walked. I was not a sedentary person,” says Gray, President of Mended Hearts Chapter 379 in Gastonia, N.C.
That’s why Gray was so surprised and scared when we wound up in cardiac rehab at CaroMont Regional Hospital after undergoing a CABG surgery there in 2011.
“I was despondent,” Gray says. “It was kind of a, ‘I wonder what’s going to happen to me’ situation. You’re really worried about your future.”
That all changed for Gray when Susan Murphy, the manager of CaroMont’s cardiac rehab facility, gave him a glimpse of hope.
“The Lord sometimes sends people in your way who say the right thing at the right time, and Susan was that person,” Gray says. He was on the treadmill and wasn’t feeling well when Murphy placed her hand on his arm and told him, “You’re going to be OK.”
“That sounds pretty simple,” Gray says. “It sounds like a normal thing to say in the normal course of what they do, but this was a very sincere situation.”
Murphy was right, too. After 36 weeks of cardiac rehab, Gray’s heart function had increased by 63%. He lost 25 pounds (and has kept it off for five years), and the 75-year-old still hits the gym three times a week. “I think cardiac rehab is one of the best things I did for myself.”
Gray could be considered the poster boy for cardiac rehab. His experience illustrates what happens when caring medical staff such as registered nurses, exercise specialists, nutritionists and others work in concert to help patients regain their full physical, emotional and psychosocial health.
Cardiac rehab can also boost heart a patients’ confidence. Six days after Willa Welter, a member of Mended Hearts Chapter 183, in Cape Girardeau, Mo., had a heart attack, she began rehab at Southeast Hospital. A little over a month later, her heart function, or ejection fraction, had increased from 32% to 54%. (A healthy adult has an ejection fraction of about 55% to 70%.)
“When I first went in, I was scared to death that I would have another heart attack,” Welter says. “They got me to walk around a track, use the machines, and they were always there to answer questions.”
The physical therapists didn’t just watch Welter walk around the track. They walked with her, coaching her with each lap. “They always said, ‘You’ve got this. You can do this’,” says Welter. “They gave me my confidence back.”
Cardiac rehab staff members support patients in nearly every step of their recovery. They prepare tailored exercise regimens, monitor vital signs during exercise and teach patients how to gauge their activity level. They also create healthy eating plans, assist with smoking cessation, help manage stress levels and medications — and teach patients how to cope with depression, anger and other emotions that may arise during recovery. Patients also get to meet others who are on their own road to recovery through cardiac rehab.
Despite the overall health benefits for heart attack survivors and patients with coronary artery disease or congestive heart failure, participation in cardiac rehab remains relatively low. Fewer than 20% of eligible patients receive cardiac rehab, according to many sources. And women, minorities and people in rural areas have especially low participation rates.
That’s the bad news.
The good news is that the percentage of referrals seems to be improving. A 2014 study in the Journal of the American College of Cardiology indicated an 81% referral rate for heart attack patients, the focus of the study, in 2012.
Mary Ann McLaughlin, M.D., cardiologist and medical director of the cardiac health program at Mount Sinai Hospital in New York City, agrees that surgeons, cardiologists and general practitioners don’t recommend cardiac rehab as often as they should. Surgeons, for example, may only focus on the mechanical problem, which they “fixed.” General practitioners have too much to cover in too little time during an office visit. “They are so time-crunched these days,” says Dr. McLaughlin. “They have such a short time period to go over medications and other issues that they may not have time to talk about rehab.”
One way researchers have found that hospitals and staff can overcome physician referral obstacles is through an automatic referral system, along with trained clinical staff who can help increase enrollment rates of cardiac rehabilitation.
To raise awareness about cardiac rehab, Mt. Sinai Hospital sends patients home with information about the program. Doctors in the catheterization lab are instructed to indicate on their report whether a patient is a cardiac rehab candidate. “When the general doctor reads that report, it will remind him that rehab is important,” says McLaughlin.
At CaroMont Regional Hospital, where Gray was treated, heart patients are invited to go to an orientation for cardiac rehab. That’s how Gray learned about it. “I figured it couldn’t do anything but help me,” Gray says.
At Southeast Hospital in Cape Girardeau, Missouri, cardiac rehab managers offer a phased approach. Heart patients begin with an inpatient cardiac rehab program, after which they are allowed to participate in a 12-week outpatient program if the patients choose to do so. “We try to get them into rehab within the first couple weeks so they don’t lose interest,” says Anita Smith, manager of Cardiac/Pulmonary Rehab at Southeast Health.
According to a study conducted by American College of Cardiology, only half of the women referred to cardiac rehab actually attend. Many theories exist on women’s reluctance, but some experts suspect that women have too many demands at home. “They’re taking care of older parents, or children, and feel that they can’t participate,” Dr. McLaughlin says. “Part of the reason they ended up with a heart problem is because they were taking care of everyone else before themselves. This is a good reminder that women have to take time out.”
Lack of access, especially for patients that live in rural areas, as well as a lack of time and money, also pose barriers, either real or perceived. Many hospitals try to accommodate time-crunched and working patients with extended hours and satellite facilities. “We’ll refer patients to a rehab facility that’s closest to where they live,” says Smith of Southeast Health. “Our foundation also provides gas cards to the heart program, which eases the burden for some patients.”
Lack of insurance coverage for cardiac rehab is a concern for some heart patients. Most insurance companies cover as many as 36 sessions for those who meet eligibility requirements, but they may only cover a portion of the cost. To accommodate patients whose insurance benefits don’t cover cardiac rehab, or only cover a portion of it, many hospitals offer a reduced self-pay rate and other arrangements. “We try to work with a person’s income level,” says Smith. “We’ll do what we can to get you in here and make the most of the time we have.”
Home-based cardiac rehab programs, although rare, and not always supported by insurers, can potentially address transportation, family and work-related barriers to participation. The patient would also need to be especially motivated. However, researchers do recognize home-based programs as a viable alternative to help patients stick to an exercise program.
One promising new development for cardiac rehab ties in with one of society’s most relied-upon devices: the smartphone. Patients that used a special smartphone app and web-based portal in addition to traditional cardiac rehab lost four times more weight than patients that used cardiac rehab alone. The findings, scheduled for presentation at the American College of Cardiology’s 65th Annual Scientific Session, suggest that the accountability that comes from frequent reporting through the app played a key role in improved dietary habits and slightly more exercise. And when it comes to heart patients, every little bit helps to prevent future cardiac events.
Cardiac rehab — with our without the help of your smartphone — offers clear, proven health benefits for heart patients. As more physicians prescribe cardiac rehab, and as more healthcare facilities address barriers to access, we can expect more heart patients to reap the benefits of cardiac rehab. The Mended Hearts community can help the cause by sharing their cardiac rehab success stories.
Welter’s 36-week stint ended long ago, but she continues to attend cardiac rehab three times a week. “I feel safe there,” she says. “From day one they treated me like family. All heart patients should do this because of the benefits it gives you in the long run.”