Cardiac rehabilitation alleviates this, however only 10 to 25 percent of heart patients have access to it. It helps if patients and loved ones are aware of cardiac detoxification and seek referral from their doctor, but there are established strategies to ensure patients’ access to these programs that we desperately need to implement. As a cardiac rehabilitation researcher for the past 20 years, I have been working with the preventive cardiology community to ensure that more patients have access to these lifesaving programs.
What is cardiac rehabilitation?
Heart disease is chronic and untreated, so it often leads to further heart attacks, such as re-hospitalization or the need for a stent – a tiny tube that is inserted into a vessel in the heart muscle to keep it open so that the oxygen-rich blood and nutrients can flow into it. But the chances of this can be drastically reduced with the low-cost, comprehensive cardiac rehabilitation approach. Cardiac rehabilitation includes exercise, diet, lifestyle and psychosocial counseling. (Pixels) Cardiac Rehab is an outpatient chronic illness management program that provides patients with hourly sessions about twice a week for several months. The programs offer structured exercise, patient education, as well as lifestyle counseling (such as diet, tobacco use, medication) and psychosocial (things like depression, anxiety, sleep, stress, sex, as appropriate). Think of it as a single market for all the proven heart disease risk recommendations provided in a coordinated manner with your doctors and primary care provider over time. We are the middle ground in a chain that supports patients to thrive. Cardiac rehabilitation “is not just broccoli and running shoes”, as our medical director wants to say. Participation reduces death and nursing by more than 20 percent, and also improves well-being and supports a return to desired life roles. However, few heart patients receive it, while other heart care recommendations, such as medication, apply in more than 80 percent of cases. As a heart rehabilitation community, we did research to find out what could fix it. This includes innovative healthcare payment models, automatic referral, clinician training courses and technology-based cardiac rehabilitation. Unfortunately things have not changed and patients are not getting the support they need.
Payment for cardiac rehabilitation
In Canada and other countries, health care providers can not directly charge government health care systems for heart rehabilitation, as they do for a stent or cardiologist visit, despite all clinical referral recommendations for patients. We advocate for this compensation or other innovative payment models, so that the offer of cardiac detoxification is more economically viable and to ensure enough points of cardiac detoxification for all the patients who need it. Automatic labeling of patients with a stent for referral to cardiac detoxification can help improve access rates. (Shutterstock) For example, if a patient undergoes stent or heart bypass surgery, the hospital could be paid a “bundle” of money that includes money not only for the procedure but also for the rehabilitation that follows. Group payments involving rehabilitation have now been released for hip and knee replacements in Ontario, for example, but we are still waiting for the heart surgeries as promised. As a supporter of cardiac detoxification, I have heard the argument that heart risks are related to lifestyle and that government-funded health systems should not be about changing individual health behaviors. This is despite the evidence that cardiac rehabilitation is cost-effective, resulting in an earlier return to work, as well as a reduction in deaths and repeated hospital visits (which are very expensive for the health system). In addition, the same unhealthy lifestyle behaviors that underlie heart disease are also linked to cancer, but we do not blame cancer patients for their condition. Undoubtedly, the lack of public policy – to ensure that citizens have access to safe green areas for exercise, sources of healthy food and fresh air in all neighborhoods, regardless of socioeconomic status, and better smoking control – is what leads to heart disease ; so governments clearly have an important role to play in lifestyle change. Participating in cardiac rehabilitation reduces death and hospitalization by more than 20 percent improves well-being and supports a return to desired life roles. (Pixabay) People need support to learn how to manage their condition and change multiple health behaviors, and to deal with the high percentage of psychosocial issues that not only hinder their ability to manage their condition, but also have worse outcomes. Other solutions include leveraging online health records so that, for example, when a heart patient undergoes stent or bypass surgery, his or her record is automatically tagged for cardiac detoxification because of its clear benefits to these patients. Systematic referrals like these increase the use of detoxification eightfold, and this is further enhanced by the training of inpatients to inform and encourage patients to enroll in bed rest.
Reaching out to patients who are most in need
Finally, we can also provide cardiac detoxification extensively using technology to reach all patients in need. Rehabilitation usage rates of 10 to 25 percent are average. Use is even lower in some populations such as women, rural and racial people as well as low-income people in Canada and around the world. And this is particularly worrying because in lower-income countries, heart disease rates are epidemic. Many middle-income countries are now developing cardiology programs as the burden of disease shifts from communicable to non-communicable. Disappointingly, these advanced centers place stents at high rates, but often neglect cardiac rehabilitation, which has lower costs and in many cases a similar or better benefit. In addition, doctors prefer to specialize in invasive rather than preventive cardiology, as they are more lucrative, so there are few clinicians to provide cardiac detoxification. Efforts are being made to increase the training of health professionals to provide cardiac detoxification worldwide. We hope their cardiology systems do not end up looking like those in high-income environments, with most of the focus and resources in acute care neglecting prevention and chronic care. When we combine all of these strategies, the cardiac detoxification community can reach out and care for the patients we need most. If you or a loved one has heart disease, ask your doctor for a referral for heart failure – it can save your life.
