by Carolyn Thomas ♥ @HeartSisters
Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic in Rochester, Minnesota, has this important advice for all heart patients:
“If your doctor recommends cardiac rehabilitation, go.
“If you’re not referred, ask.
“And if you ask, and are told ‘You don’t need it’ – find a new cardiologist!”
Based on what we already know about the shockingly low rates of physician referral to this life-saving treatment (as low as 20% of all eligible heart patients) we might expect a flurry of doctor dumping if heart patients follow Dr. Sharonne’s advice to seek out physicians who are more appropriately informed.
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 referrals and attendance among women fall short.”
So why aren’t all cardiologists recommending this evidence-based treatment program to their patients with the same enthusiasm they’re mustering to recommend a fistful of cardiac drugs to every survivor?
As I’ve written here:
“Doctors themselves are a significant obstacle to cardiac rehabilitation participation, as described in this American Heart Association report published in the journal Circulation(1):
“Given the well-documented benefits of participation in cardiac rehabilitation, it is surprising how few eligible patients are referred to rehab. A number of recent surveys have reported referral rates in the order of 20%.(2, 3) The under-utilization of cardiac rehab is particularly apparent:
- in women
- in those with low socioeconomic status
- in African-Americans
- in the elderly
“Each of these groups represents those who are significantly more likely to die within five years following a first heart attack.(4)”
As the ACC report explains, even a brief endorsement of cardiac rehabilitation by a physician has been shown to improve patient participation in this important exercise/education follow-up program. In fact, physician endorsement is one of the strongest predictors of full participation in cardiac rehabilitation.
PLEASE NOTE, Doctors: checking off a little tickbox on a discharge form or clicking a button on a computer screen is NOT an endorsement. An endorsement is taking 11 seconds to say something like this out loud to your patient:
“Cardiac rehabilitation is a terrific program for heart patients that has been proven to improve quality of life and reduce your risk of having another cardiac event – and I’d really love you to participate in this program.”
Dr. Gina Lundberg, a Preventive Cardiologist & Clinical Director of the Emory Women’s Heart Center in Atlanta, tweeted this message to her colleagues:
“Women go to Cardiac Rehab when I encourage them. Many MDs don’t encourage women to attend. MD bias problem!”
Her Tweet was aimed at her like-minded colleagues Dr. Sarah Samaan and Dr. John Erwin III, both Texas cardiologists who seem equally keen on getting more heart patients to experience the lifesaving benefits of cardiac rehab therapy.
Their ongoing online discussion topic: why do so few heart patients participate in a cardiac rehabilitation program? (Their secondary discussion topic: Do we need to change the name of cardiac rehab?)
We know that physicians’ failure to refer is a major (and utterly preventable) reason. As I quoted him here, Oregon cardiologist Dr. James Beckerman is blunt in his assessment of such failure:
“It is bad medicine to withhold life-saving treatments, and many physicians are selling their patients short.”
And if Dr. Gina herself can somehow convince her own heart patients to attend cardiac rehabilitation, what possible excuse can there be for all those physicians who are NOT referring 80% of all eligible heart patients?
But we know that there are also other practical issues that discourage cardiac rehab participation. A number of researchers have investigated why women in particular are not only less likely to attend, but also more likely to become rehab dropouts compared to our male counterparts. Reasons include:
- cost
- unavailable or unaffordable child care
- can’t get time off work
- transportation issues
- no evening/weekend programs available
- reluctance to exercise in front of men
- lack of awareness of rehab program’s benefits
UPDATE: Two years of COVID restrictions basically meant the end of all in-person cardiac rehab classes, and the introduction of several virtual (online) classes which – until in-person classes begin to offer evening or weekend sessions – will remain a viable option for many heart patients. For example: watch these free On-Demand Exercise videos from a professional Clinical Exercise Physiologist at Vancouver Coastal Health (in my opinion, not as comprehensive, of course, as in-person attendance – but a very good second choice when you have few alternatives). As with all post-cardiac activities, check with your doctor before starting this or other exercise programs.
A physician’s failure to refer in the first place should never be the reason that any eligible heart patient doesn’t participate in cardiac rehabilitation. See also: Why aren’t women heart attack survivors showing up for cardiac rehab?
But here are some examples from Real Live Patients who shared their own experiences with (or sadly, without!) cardiac rehabilitation:
♥ “I so wish I had had rehab. I went to the introductory meeting and the therapists told me that all patients had to be referred by their doctor. My doctor refused to refer me, saying it would not do me any good, and was angry that the therapists had told me it would be helpful. I begged for a referral, saying I would pay out-of-pocket, but he still refused.” (heart attack, sudden cardiac arrest, ICD implanted)
♥ “My cardiologist did not even suggest it, they did not talk about it at the hospital. I found out about it from a relative, asked for a referral and my cardiologist said ‘Fine, but I think it is a waste of time personally.’ “(heart attack)
♥ “I was referred to cardiac rehab, however my insurance would not cover it so I only went a few times. I found this to be so odd because my bill from my STEMI (heart attack) was about $250,000. That they would cover this and not the recovery and prevention of the next one leaves me scratching my head. I work managing medical billing so I am not sure why this was so surprising to me but it was. With all of the studies surrounding the benefits of cardiac rehab, it just seems so ridiculous.” (heart attack)
♥ “I did not get to go. I asked my cardiologist and it was covered through my insurance, but he said to just exercise and eat a balanced diet. I later asked him why he refused to send me, and he said it was because of my age; they had no one else going at the time under 70 and he was afraid it would cause further depression. I knew 47 was young to have a heart attack. I think it would have helped me immensely with the fear.” (heart attack)
♥ “Some doctors are negative and think cardiac rehabilitation is not needed. It amazes me that any cardiologist would discourage anyone from 12 weeks of cardiac rehab if you are eligible. For those who have been discouraged, find a new doctor who is aware of the importance of cardiac rehab. There is no room for ego in participating or encouraging someone to do something to increase their physical and emotional well-being.” (heart attack, SCAD*)
♥ “Not everyone has insurance which covers cardiac rehab. Some people have insurance which can only partially cover it, and even that can be steep. For myself, the rehab was $150 per session, and my insurance covered $100 of that cost. For 36 sessions, it cost me $1,800. Thank goodness I could afford it, but it was a shocking amount of money, especially after the cost of my hospitalization/heart attack. But in the U.S., only those with decent health plans will be able to attend cardiac rehab, it really is a therapy for the haves versus the have-nots. For me, worth every single cent I paid. It was my oasis in a time of fear. I regained my confidence in my body and in my health while at rehab.” (heart attack)
♥ “I would love to attend cardiac rehab, but trying to work full-time and having so many doctor appointments, there is no time left. My job is already in jeopardy because of being off work so much. Cardiac rehab is 3 times a week for 10 weeks and it is all during work hours. I wish they had more convenient hours for people who have to work 8 to 5. I know my heart is important, but if I don’t have my job I couldn’t pay for the cardiac rehab. Vicious circle.” (heart attack)
♥ “My doc is 70 years old. He told me he reads every night to keep up on the latest information, so I don’t think exercise or cardiac rehab is a big mystery to any doctor in this day and age. I think (doctors’ reluctance to refer) might be stubbornness or fear of change. Unfortunately this harms women. I started cardiac rehab 18 days after my SCAD, cardiac arrest, and four stents – five days in the hospital. I now go three times a week.” (heart attack, SCAD*, cardiac arrest, four stents)
♥ “Where does doctors’ bias against cardiac rehab come from? I think arrogance, actually. Cardiologists sometimes think that it is all about them, that they are fixing you, you do not need the other stuff. They think cardiac rehab is some kind of fluffy do-good yoga and meditation program rather than a serious educational and exercise program designed to give heart patients a better chance at avoiding a repeat. Honestly, I think sometimes they believe you just need the office visits, the meds and you are good to go.” (three heart attacks)
♥ “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 because I couldn’t afford it.” (SCAD*)
♥ “If doctors aren’t ‘prescribing’ cardiac rehab for those who need it, how would the patient ever know about it?” (sudden cardiac arrest)
♥ “I think cardiologists and other healthcare providers still need to be educated, or educate themselves about the benefits of cardiac rehabilitation. Then perhaps they will properly educate and motivate their patients to attend. Lastly, the nurses and others who actually run the programs must educate patients to make the necessary decisions to make time for their own recovery and not drop out of the programs.” (coronary artery disease, stents)
♥ “I did cardiac rehab for about four weeks and checked myself out. It was BORING! I am a fitness instructor so even though my insurance was paying for it, I knew I could do what they were doing at my own gym and be with my friends and people my own age.” (sudden cardiac arrest)
♥ “Cardiac rehab would have been such a help after my difficult recovery. I slept in a chair for 5 months because of lung complications. I had difficulty breathing and could barely walk. It was a long road back and I was scared to death.” (aortic valve surgery)
♥ “Went to rehab for only a few weeks before I quit. It turned out to be an Old Boys Club. VERY disappointing. I was the only woman there, much younger than anybody else (in my early 40s) and some of the men in my group were in their 80s! I was still working, had young kids at home, stressed out about how on earth I was ever going to manage going back to work, raising my boys, running a household again, all while coping with this scary angina pain. Wish our rehab program had included more than just exercise but also help with the emotional pain too. I’ve also heard about women-only cardiac rehab groups, would have LOVED that.” (coronary microvascular disease)
♥ “From personal experience, I was NOT one of those patients who ever received a referral. I even asked my cardiologist to refer me to rehab so I could get stronger. Nope. He wouldn’t do it for whatever reason.” (heart attack)
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* SCAD = Spontaneous Coronary Artery Dissection
Thanks to all of my heart sisters who took the time to share their experiences!
♥
NOTE FROM CAROLYN: I wrote much more about cardiac rehabilitation and other ways to improve your chances of survival in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).
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(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
(2) Suaya JA, Shepard DS, Normand SL, et al. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation 2007;116:1653-1662
(3) Boyden T et al. Can increasing referral to cardiac rehabilitation improve participation? Prev Cardiol 2010;13:198-202
(4) Roger VL, et al., on behalf of the American Heart Association Statistics Committee and Stroke Statistics Committee. Heart disease and stroke statistics – 2011 update. a report from the American Heart Association. Circulation 2011;123:e18-e209
Q: If you’re a heart patient who did not attend or complete a supervised cardiac rehabilitation program, tell us why
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See also:
Do we need to change the name of 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”
I was interviewed for this US News article: “Cardiac Rehab: Boosting Your Heart Recovery“
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 physically active before their cardiac event and are wondering how to safely resume their routine)
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Heart Sisters 
NOTE FROM CAROLYN: This comment has been removed because it was attempting to sell you their services. Please read the disclaimer details to learn how you too can have self-serving comments removed.
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Why does atrial fibrillation not qualify a person for cardiac rehab? AFIB and sleep apnea are commonly seen together…insurance will cover meds, procedures costing 100s of thousands, even implanted devices (loop recorders, Watchman, CPAP….) Weight loss, cardiac strength and controlling sleep apnea can all help an AFIB patient…
How do I help to get AFIB covered by insurance for cardiac rehab?
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Excellent questions, Chris. As this report from the Ottawa Heart Institute found, “While the benefits of cardiac rehabilitation programs are well established for patients with OTHER types of heart disease, current clinical guidelines for treating patients with atrial fibrillation do not include referral to rehab programs – despite these patients experiencing poor exercise tolerance, low fitness levels, poor mental health, and other disabling symptoms, such as shortness of breath, excess sweating, and difficulty sleeping.”
Where I live (the west coast of Canada) our otherwise excellent universal healthcare system funds all invasive cardiac procedures/surgeries/devices/diagnostic testing/and consultation with a cardiologist FOR LIFE – but also fails to pay for all cardiac rehab – no matter WHAT the cardiac diagnosis. My comprehensive workplace extended-health insurance also refused to pay for my rehab. Even a direct appeal from my cardiologist had zero success in getting the costs of my own 3-month cardiac rehab program reimbursed.
Failure to financially support this program, either through private or public insurance plans, seems like bad medicine. We’re talking about a Class 1 recommended therapy endorsed by every cardiology society worldwide, which has been found to reduce mortality of heart patients by a whopping 20%. That’s better than statins – yet my extended health pharmacare benefits will pay for those – but not one penny of my cardiac rehab program, and that was after surviving a widow-maker heart attack caused by coronary artery disease.
I believe that more and higher-quality scientific research is the only way to convince the powers-that-be to fund this important life-altering therapy – especially if researchers can show that cardiac rehab for AFIB patients saves money in the long run. Like many parts of healthcare, it’s all about the bottom line. . .
Take care, stay safe. . . ♥
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Had a MI in 02/2020, Ontario Canada. Not one person mentioned rehab. Saw some scribble on the hospital records when I obtained a copy.
Here it’s 2+ years out and my Cardiologist just loves to run tests. Do they really have any concept of cost benefits? Being 2+ years out, I’d be excluded from participating likely. I surely would have paid to participate.
I’m actually a bit afraid to exercise. Infuriated with how women are treated as second class citizens sometimes.
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Hello Michelle – that’s unfortunate that you were discharged from hospital two years ago without a referral to cardiac rehab – but not surprising since in 2020, in-person cardiac rehabilitation programs were cancelled due to COVID.
In a perfect world, heart patients do start rehab in the early weeks (around 6 weeks is common) – but when I double-checked with my friend Dr. Scott Lear (a professor at Simon Fraser University in Vancouver) who has a special interest in cardiac rehabilitation for all heart patients – here’s what he said when I asked him if two years might be too long after an MI to start cardiac rehab, was this:
“Anytime! Obviously the sooner the better, but cardiac rehab is valuable at any time following an MI.”
That’s just what I was going to say too! Contact your local cardiac rehab program, explain your story, and ask them if you need a doctor’s referral. If so, request that referral and then you’ll be on your way. I have a feeling you’ll no longer be afraid to exercise after this.
PS Just heard from Debbie Childerhose at Women’s College Hospital in Ontario who suggests you contact her: “I can find the rehab that is closest to her and be open to chat on what she should expect…”
Debbie’s e-mail: debbie.childerhose@wchospital.ca
Good luck to you! ♥
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I’m not going because they want me to wear a mask while exercising.
Seriously?
I’ve had my 2 shots and the mask interferes with my breathing.
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So, don’t go. . .
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I had a heart attack in early August. Started a great cardiac rehab program in October. By Nov 1st my insurance was cancelled. I needed to get early social security so they figured I was making too much money to qualify. So I’ve only done about 3 weeks of rehab and am seriously worried about recovery. I’m discovering it is only the money that matters. I’ll be 64 this month and very worried my time is running out.
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Hello Erin – what terrible timing for a recently-diagnosed heart patient!
A program of supervised cardiac rehab is indeed important, but we also know that for many heart patients (either through loss of insurance as in your case, or because they live in rural or isolated areas where the closest supervised CR program is too far away, or because they are back at work and cannot accommodate daytime-only program requirements), going to an in-person cardiac rehab program is often not practical or possible.
A couple thoughts: you might personally approach your hospital’s cardiac rehab coordinator or social worker to ask about financial aid or discounts that might help you resume your program, or look into a ‘virtual’ home-based program like the “My Heart” app that is self-guided.
That option is certainly not my favourite recommendation but a number of recent studies suggest this might be a surprisingly successful way to address some of the practical limitations of in-person programs. Best of luck to you….
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Erin – 5 stents put in on November 17, 2019. Cardiologist recommended cardiac rehab. Started on Dec 4. Went the full three months. Felt great on the day I finished.
When I got home there was an email with a statement for the month of January for $3,148.47! Dec was paid for, but when the new year started we had a new deductible on our insurance, so we will end up having to pay $6,296.94 for Jan and Feb to meet the deductible first.
That is $262 an hour. If I would have had any idea it was going to cost that kind of money, I would have only gone for Dec which was covered and just finished out doing the exercises at home.
When I opened that email, I almost had another cardiac event. I’m sorry but no treadmill, exercise bike and weights are worth that kind of money for an hour.
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That bill is simply obscene, Barb! TWO HUNDRED AND SIXTY TWO DOLLARS AN HOUR!?! And no warning note from your insurance company before year-end that told you, oh by the way, from now on, you’re cut off?!?!
This is a cautionary warning, especially for American patients, to double- and triple-check with your insurance company policy before starting ANY recommended program so you don’t make assumptions about deductibles, co-pays, and other reasons for patients getting unexpected bills like yours. Insurance companies don’t make money on approved claims – just on the claims they deny.
Weasels, the lot of them…
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I totally recommend cardiac rehab. 8 weeks ago I had the widow maker heart attack and am blessed to survive and now go to rehab 3 times a week.
We all have a good time no matter age or gender. 3 weeks and looking forward to many more.
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Good for you, Peggy! Not only are you having a good time at cardiac rehab – you’re also reducing your longterm risk of another heart attack! Keep up the great work…
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I was and am a single Mom and had a stent placed in 2015 at age 54. I needed to return to work to pay bills. I was referred to a rehab program and could not get time off of work and there was nothing after work or evenings or weekends. Every one else was 64 plus and not working!!!
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Hi Wendy – that is unfortunately a very common complaint! I encountered the same lack of services here, too. (Luckily, I was able to negotiate with my employers to take two mornings a week off for my rehab appointments, but I know how rarely that kind of accommodation is even possible).
Why do hospital bureaucrats bother offering a supervised cardiac rehabilitation program if they offer it only for the convenience of paid staff (i.e. during typical business hours)? Many programs seem to be geared to seniors only.
Note to hospitals: seniors are not the only ones who are heart patients! This failure to provide services needs to be fixed, everywhere. Yesterday!
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I’m with you 100% on the importance of cardiac rehab, Carolyn.
After exemplary treatment for my STEMI (major heart attack) here in the UK, I was visited on the ward by a cardiac rehab nurse and encouraged to join the program. Thankfully I did and received 12 sessions over 6 weeks, starting 8 weeks after my event.
I learned how to exercise safely, eat well, all about heart meds, about the psychological aspects of a heart event and the future. All this within a safe environment, in a 12 person group of men and women ranging in age between 28 and 79. The structure was a quick health check of blood pressure and oxygen saturation, then on to a warm up, circuit training and cool down, followed by refreshments, chat and education. This was termed Phase III cardiac rehab.
We were encouraged to sign up for Phase IV – cardiac rehab for life. I’m still doing the Phase IV exercise class twice a week over two years later! As a previously non-exerciser, I lost 28 lbs and gained confidence, recovery, better health and friends.
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What a great endorsement of cardiac rehabilitation, Jane! There is a good reason that cardiac rehab’s considered a Class 1 recommendation by every cardiology society worldwide. IT WORKS! With proven success rates (2/3 less likely to die if you’ve completed CR) – those are better results than taking a statin!
Phase IV – cardiac rehab for life!!!! What a concept! If only all cardiac centres modeled their post discharge care after what you have enjoyed in the UK!
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All our NHS treatment in the UK is free at the point of need and delivery. Phase III rehab was free but I now pay £5 a session for Phase IV for life with a privately run large friendly group. 30 or so of us at each session, all with cardiac issues, and family members also welcome. We have 65-85+ year olds in the group. We exercise to great music from the 1960s to present.
I hope I’m as healthy as some of the older members when I reach my 80s (if). Our exercise specialist won an Innovations Award from the British Heart Foundation.
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Lovely to hear such a strong endorsement of your National Health Service, Jane. Your Phase IV for Life classes sound terrific, and congrats to your exercise specialist for that award! (Was that the Happy Hearts group?)
Here in Canada (aka “commie pinko land of socialized medicine”), our healthcare diagnostics/treatment/follow-up are also free to patients. Cardiac rehab, however, is really hit & miss, depending on where you live in Canada, and especially where you live e.g. rural or urban areas. I had to pay hundreds of dollars for my cardiac rehab program (an unacceptable requirement that prevents many heart patients from attending!) – but I referred to it as “cheap life insurance”.
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Husband had his 3rd heart attack at the age of 48. All three times he was referred to rehab. They wanted him to go 3 days a week with a copay of $35 per visit. Even with the great insurance coverage we simply could not afford $105 a week for him to attend.
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That’s a lot of money, and especially problematic because – after a third heart attack at such a young age – cardiac rehab would have been strongly recommended for your husband. I wonder if referring cardiologists understand significant barriers like this for so many patients?
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It is the payors who demand the copay, not the hospital/facility. Nearly every insurance provider charges a copay/visit. It is a huge barrier to participation.
I’m not surprised since our current healthcare system is focused on treatment and not prevention.
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Sadly true, Erin. Focused on treatment and not prevention. Yet I’ve heard docs insist that they DID refer heart patients to cardiac rehab but they “just didn’t go” – AS IF these patients are simply being “non-compliant” instead of struggling with a number of barriers listed in this article.
It’s like watching people drowning in the pool you just threw them into because you had no idea they couldn’t swim…
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I had open heart surgery 2 months ago and was going to do rehab but will not for 2 reasons: First, I had a second heart attack the day after having a treadmill test, which I had passed. It was the result of a failed bypass. Second, the recruiter for cardiac rehab did not recognize nor respect the five stages of grief: I was in denial (still am) and she beat me over the head to “accept” I had a disease. Want to be masochistic? Go to someone that is not hopeful.
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Hello Mary – denial is indeed very common, both during and after most cardiac diagnoses. I have written lots about this predictable reality (here and here, for example).
You are still in relatively early days since your surgery. In the very early post-diagnosis period of time, denial can actually be temporarily helpful in providing space to making sense of something that makes no sense. When denial continues, however, in a way that actually endangers health (e.g. deciding not to go to cardiac rehab – an evidence-based program that has been clearly shown to reduce risks of a future cardiac event – then denial is no longer considered protective, but dangerous).
Many of us feel too overwhelmed to contemplate the hard truth at a time like this (yet the truth is, as you know, that cardiologists do not diagnose heart attacks or do procedures like bypass surgery on those who do not actually have heart disease. That is simply a fact, no matter how unacceptable that truth may appear at this point).
And I’m not sure what you would have preferred: that the cardiac rehab recruiter should have lied to you so that you could continue denying that you have heart disease? That just doesn’t seem ethically correct for any healthcare professional to do – no matter how patients might prefer to believe otherwise. I suspect you might need a bit more time to get your head wrapped around everything you’ve been going through.
You are certainly free to refuse to ever go to cardiac rehab as a way to somehow punish that recruiter, but I really hope you might one day reconsider. It’s your choice entirely.
I also hope you will contact me 10 months from now on your one-year anniversary to update me on how you’re doing. This may be hard to believe, but many of our initial reactions do change significantly over time compared to the initial grief and anger of the early days. Perhaps with the passage of time, and the realization that you do have heart disease, you might feel differently. Meanwhile, good luck to you in your recovery…
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Okay. I will try to describe this as well as I can because I am very hurt by the fact that my insurance company denied me going to cardiac rehab. I had valve replacement surgery 1 1/2 years ago. My cardiologist is good and did recommend me for cardiac rehab. My insurance company denied me.
Random people on the street who could see I was recovering told me adamantly I needed to do cardiac rehab. I had my surgery pretty young, 40 years old. And my doctors were all wanting me to recover well because I am considered young for this. Basically, trying to get well and not having much family to support me, I had no energy left to fight my insurance company and no will to exercise. I feel if I only I had a cheerleader at least I could exercise more, but I didn’t have anyone to inspire me or believe in me.
Now I am so angry at my insurance company. I hate them. I really do. I don’t have money like some people and I have to work with an insurance company I hate. I wish I didn’t have to use this insurance company, I am so angry at them. My heart condition is congenital. It was not my fault. I am much better. But I need help because I want my heart and body to have the best chance. I wish I had the energy to inspire myself. God help me. Thank you for listening.
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Hello Anna – you are not alone! Many of us are not offered any financial help to attend cardiac rehab, which is insane. As Chris commented (below), they’ll spend tens of thousands of dollars on cardiac procedures, but they won’t pay for cardiac rehabilitation, which is considered globally to be a Class 1 treatment protocol recommendation?!?!
It is maddening, but staying angry at something (like your insurance company) is likely worse for your heart health than not going to rehab. You can’t change anything about what your insurance company does or does not do – but you can change how you react to them. Please talk to your doctor about getting some help from a peer counselor, therapist, your pastor, support group or somebody who can help you feel less angry and more ‘in charge’. Even if it’s just getting out the door to walk around the park, it’s a start, one step at a time, and more constructive than staying angry at a faceless institution that isn’t going to help you. Best of luck to you…
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My insurance paid over $60,000 for my hospital bills after a STEMI heart attack and stents. They discharged me in a wheelchair to the car without ever having me walk in the hall so they could see if I could walk. I was recommended for rehab by a box checked on the discharge paper but left to my own to figure out how and where to get it..then I find out that it would cost $1,800 out of my own pocket!!
I am retired and that was a shock…I have friends who have had knee replacements and they get rehab at HOME!! at no cost even… Is a knee more important than a heart??
I did get a home nurse who came and found I was having many issues with the heart meds I was prescribed, 5, all at once…muscle pain, cramping, diarrhea, asthma and more shortness of breath. I thought they were all due to the heart attack… she was a life saver.
The whole system of get you in, get you out is a joke…
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Chris, I am spitting mad just reading this description of your (non-existent) post-discharge care plan. Your apt comparison to knee replacement patients is a compelling example of a broken system. It is so discouraging to hear over and over again that this is still going on, despite what we know about the clear preventive benefits of cardiac rehabilitation… Get you in, get you out — appalling…
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I started Cardiac Rehab. The nurses urged to make another appointment as my BP stayed very high. Two more blockages were found using intravascular ultrasound (a grumble for another time.). Went back for one more session of rehab (good thing as I knew I could get Physical without problems) and then was cut off as insurance would not pay. I spent the next six months wondering if I would have to pay $4000 plus out of pocket. It was finally written off because it was a mistake by the hospital. But I still feel I was cheated out of a program I needed.
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Hello Sue – it is beyond comprehension that insurance companies will fund expensive cardiac procedures, but fail to cover cardiac rehabilitation afterwards – which we know will help to prevent future expensive procedures! You were indeed cheated…
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My sister had a heart valve replacement in December 2016 and was recommended to go to cardiac rehab but she got scabies from the facility but at the time did not know it was from there and was contagious so she had to wait to get cleared up. Then she went back and got reinfested so she would not go back, so she asked her doctor what else she could do and he said swimming or walking at home would be fine.
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Wow, that sounds awful, Lynne. Scabies is a miserably itchy parasitic infestation – and very, very contagious, person to person. No wonder your sister didn’t want to go back to that facility. I’ve heard that scabies can recur in some people even after successful treatment is done, so it could also be a possibility that your sister didn’t get reinfected at the same place, but that this could have been a recurrence of the the initial underlying infestation. Her doctor was correct that swimming or walking are both healthy activities, they aren’t as cardioprotective as research shows a program of supervised cardiac rehabilitation is. I hope your sister’s doing much better now…
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Thanks, she gets out of breath easy and has a hard time exercising because she has bad discs in her back. She cannot stand for even 5 minutes without having to sit down. She has gained a lot of weight since her surgery and has become extremely lazy. They told her she would feel great after 6 months but not having the cardio has made her recovery difficult. She wants everything to be easy and fast. She stayed at a facility after the surgery for 3 weeks and she kept doing the exercises too fast and they had to keep telling her to slow down.
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Sigh… It’s so hard to watch a family member having trouble recovering. There’s very little you or anybody can do to suddenly motivate her. She has to make her own decisions. It’s tempting to say that your sister has become “extremely lazy” since her surgery, but it may also be that she’s depressed (very common among heart patients). Depressed people have a hard time following doctor’s orders, eating healthy, exercising (even without back problems). First her surgery, then scabies (which I hear can be absolutely horrible to live with) plus ongoing back issues and now weight gain. I hope she can arrange to talk to a professional therapist (through her church, her doctor, or a medical referral) to help her through this.
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I had my heart surgery after I had resigned from my job and 2 days before I was scheduled to start my new one, which meant that I was unemployed during my recovery period. The new employer held the job for me for 6 weeks so I only completed a little over a week before I had to go back to work. There were no after hours rehab choices otherwise I would have gladly continued.
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First, sorry I’m late responding to your comment, Thomas – it somehow got lost in the moderation lineup behind the scenes!
And I’m especially glad that I didn’t miss your comment because you bring up such an important point: access to cardiac rehab programs.
If cardiac rehab’s available only during daytime hours, it’s like saying ‘We don’t care about heart patients who have jobs!’ That is simply unacceptable. As in your experience, there are NO evening or weekend cardiac rehab programs where I live here in my town either. (Luckily, I was able to negotiate with my longtime employer to accommodate two mornings a week at rehab).
Although there is never a good time to have a cardiac event, your timing couldn’t have been worse (the two days you were unemployed?!) I hope you are doing much better these days.
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After open heart surgery I completed 36 sessions of cardiac rehab. I was referred by my surgeon. Cardiac rehab is imperative for a healthy outcome after OHS.
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Fantastic, Maria. Your surgeon is a smart person!
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I was never offered. Suffered a SCA in 2015 . Now have an ICD
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Tragic…
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That could be because cardiac arrest is not a covered diagnosis by most insurance companies.
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Whaaaat? Sudden cardiac arrest is NOT a covered diagnosis in the U.S.?
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SCA alone is not a covered diagnosis. If the SCA was a result of CHF or a MI, then absolutely it’s covered. But otherwise, yes, it’s not covered here in the US. Cardiac arrest by itself is an electrical issue of the heart, and there is no scientific evidence that electrical disorders of the heart benefit from exercise.
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Wow… it’s true that SCA can also be caused by things like severe physical stress or inherited arrhythmias (like Brugada or long QT syndrome). Thanks for clarifying…
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I had mitral valve repair and triple bypass surgery June 9 2016. I have been in cardiac rehab since August 2016. Twin County Regional Hospital in Galax Va. is where I have my rehab. The staff is great and I would recommend them to everyone. The rehab is very important.
Gerry Rider
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That’s great, Gerry! I wish all heart patients could have the same referral to cardiac rehab that you have had! Best of luck to you…
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Right after getting stents put in, I showed up for the evaluation, but I barely made it through. I walk with a rollator because of arthritis in my hip and knee. I was so winded and tired I just didn’t go back. It turned out the doctor had put me on a blood thinner my body couldn’t handle. They had to change it.
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Hello Ruth – so glad you got that sorted out! Hope you recovered enough to go back to that cardiac rehab program.
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It was too expensive for me to attend – even while Humana covered some of the cost. I would have had to pay $1,600 of my own money. That’s ridiculous when seniors are on a fixed budget. I think it costs so much because of the medical assistance, but the exercising is more important. Instead, I joined the Silver Sneakers program that was free under Humana Medicare. The local YMCA had similar machines. You are just not watched by the clinic assistants. So there’s alternative ways to exercise your heart without the expensive cost. I wonder if it’s just an excuse or way for the clinic to make extra money. People can also walk a couple of miles 3 times a week and do as much good.
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Hello Lou – $1,600 for the patient portion of cardiac rehab is absolutely insane! (For that kind of money, I could hire a private nurse to go with me each week!) In our program here (my cost: under $400 for four months, twice a week), we were supervised by a cardiac nurse who oriented us to the exercise program, took our vitals, monitored our progress throughout, and – on at least two occasions – stopped me in mid-workout because she could tell I was in trouble. There IS a difference, however, between a supervised cardiac rehab program and walking three times a week – the research proves repeatedly that exercise alone is not “just as good”. Both types are useful, but we know that supervised cardiac rehab saves lives especially for those with complex cardiac outcomes. It needs to be covered for everybody, just as cardiac procedures in the cath lab or OR are covered.
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