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Marie A. Bass: AACVPR (312) 321-5146 mbass@aacvpr.org
Amy Murphy: ACC (202) 375-6476; amurphy@acc.org
Cathy Lewis: AHA (214) 706-1324; cathy.lewis@heart.org
September 20, 2007
New Standards Aim to Boost Participation
in Cardiac Rehabilitation
Referral to cardiac rehab could soon be as automatic as
giving aspirin during a heart attack
(WASHINGTON, DC)—No one would even think of hurling
oneself from an airplane without a parachute, nor walking
a tightrope for the first time without a safety net. But the
majority of patients who have a heart attack or other serious
cardiac illness start a new, high-risk stage in life without
the support of cardiac rehabilitation—even though such
programs provide a safety net as effective as leading cardiovascular
medications.
All that may change soon, following the release of a new
set of performance measures aimed at boosting patient enrollment
in cardiac rehabilitation programs and setting standards of
excellence for program operation. The new document is the
result of a collaboration between the American Association
of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the
American College of Cardiology (ACC), and the American Heart
Association (AHA). In addition, it has been endorsed by nine
medical societies specializing in cardiac care and rehabilitation.
It appears in the October 2, 2007, issues of the Journal
of the American College of Cardiology (JACC) and Circulation
and the September/October issue of the Journal of Cardiopulmonary
Rehabilitation and Prevention (JCRP). It is also available
on the websites of each of the collaborating organizations
(www.aacvpr.org,
www.acc.org, and www.americanheart.org).
“This is a call to arms,” said Randal J. Thomas,
M.D., M.S., who directs the Cardiovascular Health Clinic at
Mayo Clinic, Rochester, MN. “Cardiac rehabilitation
is extremely beneficial to patients—there’s plenty
of evidence of that—but it’s vastly underutilized.”
Thomas says studies have shown that cardiac rehabilitation
programs, also known as secondary prevention programs, help
improve the health and life expectancy of people with heart
conditions like heart attack and heart bypass surgery. For
example, they reduce the risk of death after cardiac illness
by 20 to 25 percent—a level of benefit similar to that
of statin drugs, beta blockers and aspirin. They can also
boost physical strength and endurance by 20 to 50 percent,
an improvement that could determine whether a patient is able
to return to an active life.
“We have patients whose goals range from simply getting
out of the house to returning to active-duty military,”
said Marjorie King, M.D., who directs cardiac services for
the Helen Hayes Hospital, West Haverstraw, NY. “Cardiac
rehab helps everyone in different ways.”
Although cardiac rehab is often thought of as medically supervised
exercise, physical conditioning is just one component. It
is also a coordinated program that assesses each patient’s
clinical condition and risk factors, provides education and
support for living a healthier life, and works to prevent
repeated episodes of cardiac illness, such as a second heart
attack.
“Without cardiac rehab, patients don’t know what
they can and can’t do, so they may sit on the couch
and watch TV. They may not get any help to stop smoking, so
they continue to smoke. They may not get any help to lose
weight, so they gain even more weight,” Dr. King said.
A wide range of patients is eligible for cardiac rehabilitation/secondary
prevention programs. Anyone who has recently had a heart attack,
coronary artery bypass surgery, angioplasty, stenting, heart
valve surgery, heart and/or lung transplantation, or has experienced
chest pain caused by narrowed coronary arteries can sign up.
Fewer than 30 percent of eligible patients participate, however,
often because many patients are never referred to a program
or they cannot afford it.
One goal of the new performance measures—which are
akin to report cards used to gauge adherence to recommended
clinical guidelines—is to make referral to cardiac rehab
as automatic as giving aspirin during a heart attack. The
document even provides sample referral forms and outlines
the best approach to collecting and analyzing data on patient
referral to rehabilitation and prevention programs.
“Only a minority of eligible patients receive the full
benefits provided by cardiac rehabilitation/secondary prevention
programs today,” Dr. Thomas said. “We hope that
healthcare providers, healthcare systems and health insurance
carriers will work together to help all eligible patients
participate in such programs.”
A second goal of the new performance measures is to ensure
the safety and excellence of cardiac rehabilitation programs.
In fact, one section sets standards on everything from medical
supervision, to the thoroughness of patient assessment and
monitoring, to accountability for documenting patient progress
and program performance, and the need for effective communication
with the patient’s private physician.
“A good cardiac rehabilitation program serves not only
as a coach for the patient, but also as a communicator and
coordinator with other healthcare providers, so patients get
the follow-up care they need,” Dr. Thomas said.
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About the American Association of Cardiovascular
and Pulmonary Rehabilitation:
Founded in 1985, the American Association of Cardiovascular
and Pulmonary Rehabilitation (AACVPR) members comprise all
professionals who serve in the field of cardiac and pulmonary
rehabilitation. Members include: cardiovascular physicians,
exercise physiologists, cardiopulmonary physical therapists,
pulmonary physicians, cardiac nurses, dieticians, respiratory
therapists and others. Central to the mission is the improvement
in the quality of life for patients and their families to
reduce morbidity, mortality, and disability from cardiovascular
and pulmonary diseases through education, prevention, rehabilitation,
research, and aggressive disease management. AACVPR oversees
the well-respected Program Certification program for Cardiac
and Pulmonary Rehabilitation facilities and publishes the
peer-reviewed Journal of Cardiopulmonary Rehabilitation and
Prevention. For more information, visit www.aacvpr.org
About the American College of Cardiology:
The American College of Cardiology is leading the way to optimal
cardiovascular care and disease prevention. The College is
a 34,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. For more information visit www.acc.org.
About the American Heart Association:
Founded in 1924, the American Heart Association today is the
nation’s oldest and largest voluntary health organization
dedicated to reducing disability and death from diseases of
the heart and stroke. These diseases, America’s No.
1 and No. 3 killers, and all other cardiovascular diseases
claim over 870,000 lives a year. In fiscal year 2005–06
the association invested over $543 million in research, professional
and public education, advocacy and community service programs
to help all Americans live longer, healthier lives. To learn
more, call 1-800-AHA-USA1 or visit americanheart.org. The
American Heart Association now has a Web site dedicated to
cardiac rehabilitation. The site is designed to complement
a traditional rehab program by providing patients and caregivers
with resources to both understand their conditions and make
the necessary lifestyle choices to prevent future cardiovascular
events. Visit americanheart.org/cardiacrehab
for more information.
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