After a Heart Attack

Featured Article, Healthy Heart, Heart attack
on June 7, 2011
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If you’ve survived a heart attack, you’re likely feeling extraordinarily grateful. But you also probably realize that the hard recovery work is just beginning.

“If you ask most people what are the right things to do after a heart attack, they can recite them,” says Dr. John Bisognano, director of outpatient cardiology at the University of Rochester Medical Center in Rochester, N.Y. “But in order to accomplish them, people actually need the tools and the support to do it. A formalized cardiac rehab program gives them those tools.”

Yet a Canadian study released in February found that 70-80 percent of patients with coronary artery disease in the United States, Canada and the United Kingdom do not complete the recommended 36 sessions of rehabilitation typically recommended after a cardiac event like a heart attack, angioplasty or stent procedure.

Here we address some of the most common excuses for not completing cardiac rehab and offer ways to stay motivated to do the work.

Excuse No. 1: “I’m scared to work out.”

It’s natural to feel skittish after a heart attack, but the chances of having another cardiac event when you return to exercising are very low, says Dr. Bisognano. That said, it should give you some peace of mind to work out in a supervised setting.

“Many people feel more comfortable being surrounded by people who are medically trained,” says Dr. Bisognano. “It’s a safe environment.”

Excuse No. 2: “It’s too much of a hassle to get to the center. I’ll walk or go to my gym instead.”

Having to travel to a rehab center 2-3 times a week is one of the biggest barriers to completing the program. But a gym visit is not an acceptable substitute.

“People think cardiac rehab just going in and exercising, but it’s not,” says Dr. Bisognano. “Patients also get dietary advice and depression screenings.”

Depression is common after a cardiac event, and it often creeps up later, after the initial shock has worn off. It’s crucial for cardiac patients to be monitored for signs of depression, and the consistency of cardiac rehab makes that easier.

Most hospitals have some kind of cardiac rehabilitation facility, though they vary in size. If the hospital where you were originally treated is not convenient, look into the possibility of completing your rehabilitation at another center, or even via home visits, which some hospitals offer.

Excuse No. 3: “It’s too expensive.”

Though Medicare covers the recommended 36 sessions of rehab after a cardiac event, many insurance providers require a co-pay with each cardiac rehab visit, which at 2-3 visits a week can add up. If the cost is truly prohibitive, talk to your doctor to see if he or she can recommend a way to defray the cost, or intervene with your insurance company.

But if it’s just a matter of frustration at the cost, consider this: In a 2010 study, patients who completed 36 sessions of cardiac rehab cut their risk of death in half, and reduced their risk of a heart attack by a third, compared to patients who only completed one session. The same study found a direct correlation between the amount of sessions completed and the risk of death and subsequent heart attacks, i.e. those who completed 24 sessions fared better than those who only did 12, but doing 12 was better than none. How much is your health worth to you?

Excuse No. 4: “I feel fine.”

“Unlike people who had heart attacks in the 1980s, many of today’s heart attack patients feel pretty good afterward,” says Dr. Bisognano. That’s partially due to the fact that smaller cardiac events are being detected, which classifies more patients as heart attack survivors than ever before. But make no mistake: No matter how you feel, if you’ve had a heart attack, your lifestyle requires some changes.

Excuse No. 5: “I know what I need to do.”

It’s true that the lessons you learn in cardiac rehab may not surprise you. After a heart attack, most patients are urged to adopt a lower fat, lower sodium diet and begin an exercise regimen. But the rehab process is not just about learning about how to change your lifestyle. It’s also a source of support.

“There are benefits to being in a room of people who all have had similar medical problems,” says Dr. Bisognano. “There’s a camaraderie. It’s similar to Weight Watchers—it gives you the support to make changes successfully.”

That support can not only make it easier to implement change, but also help prevent depression.

“Most people don’t expect to have a heart attack,” he adds. “It helps to see people just like them who are going through it.”