Recent news that the Centers for Medicare and Medicaid Services has expanded coverage to include cardiac rehabilitation for patients with chronic heart failure has me thinking about positive strides that have been made in the field.
Cardiac rehabilitation is a safe, proven way to reduce risk factors for heart disease. By reducing deaths and increasing the quality of life for those with cardiovascular issues, many professionals, including myself, feel cardiac rehab is the most important intervention that a patient can take advantage of. Most patients undergoing cardiac rehab have had a myocardial infarction (heart attack), stent placement, or coronary artery bypass surgery.
More than four years ago, a Duke University study showed that those having cardiac events who took advantage of cardiac rehab were far more likely to avoid subsequent heart attacks than those who did not attend, or went only a few times. The rate of heart attack was consistently lower among those who attended more than 24 sessions and highest among those attending fewer than 12.
Medicare and most insurers reimburse eligible patients for 36 sessions of cardiac rehab. Now this is true for those suffering from the chronic heart failure. And yet, fewer than 20 percent of patients eligible for cardiac rehabilitation ever receive it.
Barriers to participation in a cardiac rehabilitation program include low patient referrals from physicians, a lack of motivation among patients who don't see the true value, limited insurance reimbursement and geographic restrictions.
A lot of people think cardiac rehab is essentially going to the gym. It's definitely not. You won't find medically-trained, cardiovascular specialists supervising at the local fitness club. Cardiac rehab is not an exercise program you complete in a few months, then go about your life as usual. Like losing weight, it is a lifetime commitment.
At the Carondelet Heart Institute. Cardiac Rehab is designed to help heart patients reduce and control risk factors for future attacks, improve cardiovascular fitness and, most importantly, promotes wellness through lifestyle changes.
This process takes place through several "phases", the first of which starts in the hospital following a cardiac event. Many patients are highly motivated in the hours following treatment for a heart attack. Cardiac Rehab nurses begin advising on the lifestyle changes needed to promote cardiac wellness to fit the individual patient's needs.
Phase II begins shortly after discharge from the hospital. The changes presented in Phase I are reinforced and advanced. Monitored exercise sessions, lasting about an hour, are available Monday - Friday at varied times for participants' convenience. Phase II continues for 36 visits. After completion of Phase II it is often voiced from the patient how much better they feel and how much Cardiac Rehab has made a difference in their lives.
Phase III is a maintenance program that provides a safe and enjoyable atmosphere for individuals who have completed Phase II and wish to continue on with their lifestyle choices and changes adopted during their rehab.
Phase IV is a monthly maintenance program that allows for patients to exercise on their own but remain accountable by returning once a month. Another way patients remain accountable is through attending our quarterly support group meetings. Support group meetings have proven to be very successful in long-term success.
It's important to know that Medicare and most other insurance plans cover cardiac rehab programs. Patients typically qualify if they've had a heart attack, angina, angioplasty, stents, open-heart surgery or a heart transplant. And now, with this latest decision from CMS, those with chronic heart failure now have this great healthcare opportunity available through Cardiac Rehab as well.
Susan Brawner is the Nurse Manager of Cardiac Rehabilitation at St. Mary's Medical Center. She can be reached at 816-655-5664.