TORONTO — Mending broken hearts — the vital blood-pumping organs that have gone through surgical repairs, transplant or heart attacks — is the focus of research released on Valentine’s Day.
In particular, it looks at cardiac rehab programs, which are known to reduce death rates by 25 per cent for heart patients, and observes that only 20 to 30 per cent of cardiac patients are being referred to them.
Ensuring that heart patients get automatically referred as they’re leaving the hospital can make a difference, argues Sherry Grace, of York University and the University Health Network, and her colleagues in the paper published Monday in the journal Archives of Internal Medicine.
People who have had chest pain or angina could also benefit, she says, and congenital heart patients are being tested to see how much rehab can help them too.
“Rehab itself costs only $1,500 per patient whereas a bypass surgery, for example, can cost $40,000 and up,” said Grace, director of research for the cardiovascular rehabilitation and prevention program at Peter Munk Cardiac Centre.
“So if we are by this $1,500 preventing a lot more bypass surgeries and rehospitalizations down the road, it’s a real win-win in terms of the cost benefit and the health-economics of chronic disease management and cardiac rehab.”
The team studied 2,635 patients with coronary artery disease at 11 Ontario hospitals. The patients filled out surveys while in the hospital, their medical charts were studied, and more than 1,800 patients completed a follow-up survey a year later.
The researchers interviewed hospital staff and asked about the various strategies for referral.
Some used a liaison strategy that involved a nurse or physiotherapist talking at the bedside to the heart patient before discharge, giving specific information about rehab, where it’s located, seeing if there are any questions and making the referral.
“It really helps patients to become engaged,” said Grace.
Other hospitals might have a discharge checklist that mentions rehab, or an electronic medical record to facilitate the referral to the outpatient program, she said.
“We show that we can get 85 per cent of patients off a given ward referred to rehab, and 70 per cent enrolling in the program when we use these kinds of strategies,” she said.
Joe Walters, 55, of Toronto was diagnosed with atrial fibrillation — an irregular heartbeat — after finding himself short of breath and unable to walk up stairs. His cardiologist referred him to a 33-session program of cardiac rehab at Toronto Western Hospital.
Orientation with a group of other patients involved hearing from a nutritionist, psychologist, pharmacist, kinesiologist and cardiac nurses, he said.
They received information about getting exercise, quitting smoking, changing diet and other issues, he said.
Walters went to the program two or three times per week for about 12 weeks.
“Basically they would take your pulse, your blood pressure before you exercised, and all the exercises were monitored,” he said. “They would keep track of your weight. And basically I lost weight, which was good.”
Gaining knowledge about how to reduce his risks caused him to act, he said.
“I was a casual smoker and I stopped smoking and I haven’t touched a drink. I never was a big drinker. ... I try to get my exercise in every day, at least half an hour of walking or whatever,” he said.
More people with heart conditions should talk to their doctor about getting into a cardiac rehab program, he recommended.
Grace said referrals are a bit haphazard, and sometimes hospital doctors will think the family doctor will take care of it, or a cardiologist might plan to make the referral a few months down the road.
“They might do it or they might forget. And so we really need to systemetize and make the process seamless.”
Although in-person cardiac programs might not be available in rural areas, Grace said home-based cardiac rehab can be beneficial. Patients receive an educational pamphlet and receive telephone calls at regular intervals from staff at a rehab program.