Failure to refer: why are doctors ignoring cardiac rehab?

by Carolyn Thomas     @HeartSisters

Anne-Marie felt nervous after she was discharged from hospital following triple bypass surgery. She had only her immediate family to help her at home. And as she described:

“I felt like I fell through the cracks. When I left the hospital, my husband was given a sick woman in a wheelchair and a big bag of pills. I had heard about cardiac rehabilitation, so I followed up to see if I could join a program as I thought this could help me get back on my feet.

“But I was told they would get back to me. When they finally did – 15 weeks after my operation – I was already back at work, so couldn’t attend. I wasn’t offered any other alternative.”

When the British Heart Foundation’s National Audit of Cardiac Rehabilitation report was published, a blunt analysis by their auditors concluded that “cardiac rehabilitation remains a Cinderella service.” 

But the grim reality is hardly less Cinderella-ish on this side of the pond. And the reason so many freshly-diagnosed heart patients like Anne-Marie are falling through the cracks lies squarely with the doctors who are failing to refer their patients to cardiac rehab. Continue reading “Failure to refer: why are doctors ignoring cardiac rehab?”

Why you should hug your cardiologist today

by Carolyn Thomas     @HeartSisters

hugI like to tell my women’s heart health presentation audiences that, if you’re going to have a heart attack, you should really try to have one here in Victoria, British Columbia – or in any other city that boasts a healthy ratio of cardiologists-per-square-city-block.

My theory on this is that cardiologists, just like the rest of us, want to raise their families in a charming historic town with good schools, good restaurants, good shopping, fun night life, live theatre, sports teams, 200 km of cycling trails, a symphony orchestra, picture-postcard ocean/forest/mountain scenery, and a near-perfect coastal climate allowing them to garden or play golf 12 months a year. If this town also has a major university and a good-sized teaching hospital that attracts both students and cardiac researchers, that’s also going to go a long way in appealing to cardiologists.  You’re welcome, Tourism Victoria . . . Continue reading “Why you should hug your cardiologist today”

Why your heart needs work – not rest! – after a heart attack

by Carolyn Thomas  @HeartSisters

After surviving a heart attack, I couldn’t wait to start my 4-month cardiac rehabilitation program so I would just start feeling “normal” again. But when I showed up for my first assessment, I was disappointed by the cardiac nurse’s recommendation that, because of ongoing issues, I should wait two months until I felt much stronger before starting. A Canadian study from the University of Alberta now suggests, however, that earlier might just be better for many.

For best results in most clinically stable patients after a heart attack, these new findings suggest that early exercise as well as prolonged exercise may well be the key to the best post-heart attack outcomes.  Continue reading “Why your heart needs work – not rest! – after a heart attack”

“I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack

by Carolyn Thomas  @HeartSisters

“This is the most thorough review article I have seen on psychological interventions after heart events,” writes cardiac psychologist Dr. Stephen Parker* about a U.K. study on heart patients. And he should know. Dr. Steve is also a heart attack survivor himself who has explored his own profound experiences with the depression and anxiety that commonly accompany any cardiac event.

The study, reported in the British Journal of Cardiology in July 2010, followed over 400 London heart patients for two years – of whom at least half showed symptoms of anxiety or depression when first interviewed.  But the study authors described their participants in this way:

“Many of these heart patients were reluctant to accept a diagnosis of anxiety or depression and expressed reservations to the clinical psychologist by rejecting the term ‘depression’ for describing their problems, or by expressing negative views about attending a mental health service for treatment.”

In fact, these ‘negative views’ associated with the stigma of having mental health problems were so strong that all psychological interventions studied were provided to heart patients as part of a scheduled Cardiac Rehabilitation program at St. Thomas’s Hospital in London – instead of at a mental health facility.   Continue reading ““I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack”

‘Women-only’ cardiac rehabilitation curbs depression for heart attack survivors

by Carolyn Thomas  @HeartSisters

On any given day, women are vastly outnumbered by men at cardiac rehabilitation – when they show up at all. Female heart patients who do attend while recovering from a cardiac event often say they don’t like working out in the cardiac rehab gym alongside so many men – in fact, there’s usually a one-to-five ratio of women to men. To address this concern and attract more women heart attack survivors, some programs are now offering female-only cardiac rehab sessions.

This is a good thing, as we know that a cardiac rehab program can help survivors improve their physical fitness, learn about nutrition, meet other heart patients, and get support to quit smoking, lose weight or make other heart-healthy lifestyle changes to improve heart health. In fact, completing a course of cardiac rehabilitation can result in a 26%-40% reduction in cardiac mortality over the following five years.

But those improved odds are only possible if physicians actually refer their heart patients to rehab.

Yet referral rates remain shockingly low – it’s estimated that only 20% of all eligible patients are referred by their physicians.  See also: Failure to refer: why are doctors ignoring cardiac rehab?

Depression is another factor that can keep us away from cardiac rehab. 

Depression often follows a heart disease diagnosis (Mayo Clinic cardiologists tell us that up to 65% of survivors suffer depression, yet fewer than 10% are appropriately diagnosed).  Depression is also in general twice as likely to affect women as men. Depression interferes with how well we can stick with important lifestyle modifications following a cardiac event,  as well as our willingness to even bother showing up for cardiac rehabilitation.

It turns out that a major benefit of attending and completing a cardiac rehab program after a heart attack is that symptoms of depression actually improved among women who participated in a motivationally-enhanced cardiac rehabilitation program exclusively for women, according to a presentation at November’s American Heart Association’s annual scientific meetings.  Continue reading “‘Women-only’ cardiac rehabilitation curbs depression for heart attack survivors”

Why aren’t female heart attack survivors showing up for cardiac rehab?

by Carolyn Thomas  @HeartSisters

After a cardiac event, a 2-6 month program called cardiac rehabilitation can help survivors gradually improve their physical fitness, learn about nutrition, meet other heart patients, and get support to quit smoking,  lose weight or make other heart-healthy lifestyle changes to improve heart health. Cardiac rehab can reduce mortality by 25-40%, reduces angina symptoms, increases functional capacity, improves lipid (cholesterol) levels, reduces smoking by 25%, enhances psychological well-being, and improves exercise tolerance for all – including the elderly, frail or people with congestive heart failure.

Cardiac rehabilitation really works!  We know that completing a program of cardiac rehab can be very effective in reinforcing improved habits.  A 2001 University of Calgary research team lead by Dr. Kathryn King found that six months after finishing cardiac rehab, participants demonstrated higher health maintenance expectations and overall behaviour performance scores – and these indicators continued to improve over time.

But when I did a 4-month stint at cardiac rehabilitation after my own heart attack, I was vastly outnumbered by male participants, and was also one of the youngest in the group by at least two decades. Where did all the women go?  Continue reading “Why aren’t female heart attack survivors showing up for cardiac rehab?”