Once discharged from hospital following my heart attack, I was gobsmacked by how physically frail I felt. Simply taking a shower meant a 20-minute lie down to recover. Just walking to the corner with my son, Ben, required me to clutch his arm for support. But it wasn’t only this new weakness that alarmed me. As a former distance runner, I felt suddenly afraid of any exertion that might bring on the horrific heart attack symptoms I’d so recently endured. That’s where cardiac rehabilitation (a 2-4 month supervised exercise and education program for heart patients) literally saved me. Cardiac rehab does indeed save lives. According to The American College of Cardiology (ACC):
“Women with coronary artery disease who completed a 12-week cardiac rehabilitation program were two-thirds less likely to die compared to those who were NOT referred to the program.
“In addition, the mortality benefits of this evidence-based program derived for patients with angina, or for those recovering from heart attack, coronary artery bypass graft or implanted stents appear to be much more striking in women than in men with the same condition.”
Yet despite the known evidence-based benefits of cardiac rehab for heart patients, participation rates are absolutely dismal – for many reasons. The most alarming reason is this one: a 2012 American Heart Association report suggested that doctors themselves are “a significant obstacle to cardiac rehabilitation participation”: only 20% of all eligible heart patients are referred by their physicians to cardiac rehab (1). We know this referral is critically important. As the ACC report explains, physician endorsement is one of the strongest predictors of full participation in cardiac rehabilitation. It’s also why Oregon cardiologist Dr. James Beckerman, in his book Heart To Start, is blunt in his assessment of those doctors who fail to refer their patients to cardiac rehab:
“It is bad medicine to withhold life-saving treatments, and many physicians are selling their patients short.”
Some researchers suggest that our physicians may simply be “unaware” that in current practice guidelines of all cardiovascular societies worldwide, cardiac rehabilitation for heart patients is a Class I recommendation (which means that a procedure/treatment should be performed/administered).
By comparison, as I’ve observed here, I’ve never heard of a cardiologist anywhere, at any time, ever who is “unaware“ of the routine prescription of DRUGS to every survivor of every possible cardiac event.
Yet even when informed doctors do prescribe a cardiac rehab program for their heart patients, we know that there are other obstacles, particularly for women, to both attendance and completion. See: Why aren’t women heart attack survivors showing up for cardiac rehab?
Cardiologist Dr. Gina Lundberg also wonders if perhaps even the name itself could be the culprit. Are the words cardiac “rehab” simply off-putting for some patients and their physicians?
For example, Dr. Gina (a Preventive Cardiologist & Clinical Director of the Emory Women’s Heart Center in Atlanta) tweeted this recently to me (@HeartSisters) and to Texas cardiologist and keen cardiac rehab proponent Dr. John Erwin III (@HeartOTXHeartMD):
Should we change the name? As I like to do when faced with such a good question, I go straight to Real Live Patients, the women with actual firsthand experience of cardiac rehab. Here’s how some of my heart sisters feel about changing the cardiac rehab name:
♥ “The name ‘cardiac rehab’ is called that because it’s cardiac rehabilitation. I don’t understand the name cardiac ‘rehab’ being offensive, construed as addiction rehab or anything other than calling it the appropriate name: cardiac rehab.” (heart attack, SCAD*)
♥ “My feeling – it is what it is. You can change the name to whatever you wish. It still is the same program. To me it didn’t matter the name, it was the benefits that I derived from it. Also, let’s face it, most of us knew the benefits of exercise prior to our heart issues. What we lacked was the discipline and/or the support of others in our quest to exercise.” (heart attack, double bypass surgery)
♥ ” The name ‘cardiac rehab’ helps me remember why I go, and it drives me on.” (heart attack, three stents)
♥ “I think the name is just fine. I only attended for about six sessions. It was good, but I had to pay $60 for each session and find a babysitter each time I went, so I had to stop.” (SCAD*)
♥ “My current cardiologist is not a heart failure specialist but continues to support my participation. He said that the name ‘cardiac rehab’ is a misnomer. The heart is not rehabbed by the exercise, but it improves the overall functioning of the body.” (heart attack, heart failure)
♥ “Cardiac rehab name is fine, it’s the cost and scheduled time of classes that are the problem. Cardiac rehab is scheduled during the day and so isn’t an option for those who have to work.” (mother of a SCAD patient*)
♥ “Maybe they should call it cardiac resurrection instead of cardiac rehab. Thankful to God every single day for my second chance. I pay for it out of my own pocket. I’m worth it!!!!!” (heart attack, SCAD*, cardiac arrest, four stents)
♥ “Hey, I like that term cardiac resurrection, that is kind of what it is. Maybe use a spa term like cardiac rejuvenation or cardiac retraining. Then we could call them personal trainers; we could look at it as training rather than rehabbing. Or maybe use the term cardiac education, because that is what it was, too: education in a subject that I knew nothing about. And it trained me how to live for the rest of my life.” (three heart attacks)
♥ “I personally think the term ‘rehab’ is a very big deterrent. It immediately conjures up images of drug addiction or of being completely incapacitated. I know that when I was referred to ‘cardiac rehab’, I had to deliberately make myself swallow my pride. Had it been termed something like cardiac recovery enhancement program, I might have had a much better attitude. Following my heart attack, I did go to our local cardiac rehab program and learned heaps. My cardiologist at that time offered me NO advice what so ever!!!!!” (heart attack, coronary artery spasm, coronary microvascular disease)
♥ “I have no problem with the label ‘cardiac rehab’, because that’s exactly what it was for me.” (heart attack)
♥ “There is no room for shame in the word ‘rehab’ whether it’s cardiac, addiction, pulmonary, etc. – they are all diseases. People in any kind of rehab are working at getting well. We are all so lucky that we get to go to any rehab that strengthens our minds, bodies, and souls. Focus on the getting well part.” (heart attack)
♥ “Funny story: I ran into someone on my way to my cardiac rehab class. They asked where I was headed. I said to rehab. Few days later a totally different person comments to my husband that they are not surprised I had a heart attack – with my drug use! I have personally recommended cardiac rehab to many people and always found myself having to explain it, so perhaps it is a question of changing the image it promotes?” (three heart attacks)
♥ “I don’t know why ‘rehab’ has such a negative connotation. If something isn’t right, it is rehabbed. And rehab is not just for addiction. There are many rehab hospitals that deal with physical illnesses. My daughter-in-law is a Physical Medicine and Rehabilitation physician. She works with head, spinal, and other injuries to help them recover. She does not work with alcohol or drug addiction as a primary concern. Rehab is a fast-growing area of medicine. I think the problem with the negative connotation may be in society’s problem with addiction and many persons’ inability to see addiction as an illness, not a choice.” (heart attack, sudden cardiac arrest)
♥ “I went to cardiac rehab for 36 visits. I don’t particularly object to the name.” (heart attack, quadruple bypass surgery)
♥ “There are a lot of older guys in my cardiac rehab. They’ve kind of adopted me as their cheerleader. They call the rehab ‘cheap life insurance’. I like the name ‘cardiac rejuvenation’. I can feel my arteries clearing up already!” (heart attack, stents)
♥ “The ‘rehab” name didn’t bother me – instead my favorite song to treadmill to became Amy Winehouse’s Rehab (No, No, No)!” (coronary artery disease, two stents, congestive heart failure)
* SCAD means Spontaneous Coronary Artery Dissection
.Thanks to my heart sisters who took the time to share their opinions and stories!
.Q: Do we need to come up with a new name to replace “rehab”?
(1) Arena, R et al. Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings. A Science Advisory From the American Heart Association. Circulation. January 30, 2012
NOTE FROM CAROLYN: I wrote more about the importance of cardiac rehabilitation – no matter what you call it! – in my new book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press, November 2017).
- Returning to Exercise (and Training) After Heart Surgery (THE best and most comprehensive overview on this topic I’ve seen yet, written by cardiologist and triathlete Dr. Larry Creswell; especially useful for heart patients who have been regular exercisers before their cardiac event and are wondering how to safely resume their routine)
- The surprising reasons heart patients don’t go to cardiac rehab
- Failure to refer: why are doctors ignoring cardiac rehab?
- ‘Women-only’ cardiac rehabilitation curbs depression for heart attack survivors
- Why aren’t women heart attack survivors showing up for cardiac rehab?
- Study: “91% discharged from hospital without care plan”
- Why your heart needs work – not rest! – after a heart attack
- Cardiac Rehab: Boosting Your Heart Recovery (article in US News mentions this blog)