The Importance of Rehab after a Heart Attack

Summarized by Robert W. Griffith, MD
December 5, 2005

Introduction

People who have survived a heart attack are often cautious about undertaking certain activities afterwards, for fear of precipitating another attack. There are numerous programs directed at the after-care of such patients, but often the emphasis on exercise tends to discourage full participation. In fact, fewer than half those with coronary artery disease actually take part in such programs, even when healthcare programs fund them.

Scientists at the University of Alberta have analyzed 63 published reports of the outcomes of rehabilitation programs, and published their findings in the nnals of Internal Medicine. Here's a summary of their results.

What was done

The researchers selected studies that covered three main types of cardiac rehabilitation programs: a) education and counseling about coronary risk factors combined with a supervised exercise program; b) education and counseling without any exercise component; c) supervised exercise program only.

They counted the frequency of death (from any cause) and a repeat heart attack, and calculated the risks for each type of program.

What was found

The risk of death was significantly reduced by a rehabilitation program, overall - the 'risk ratio' (RR) was 0.85 for all-cause mortality, meaning that the use of any rehab program reduced the death risk by 15%. But the type of program played a role, as the table of RRs shows:

	All-cause Mortality	Repeat Heart Attack
Overall	0.85	0.83
Counseling & Exercise	0.88	0.62
Counseling alone	0.87	0.86
Exercise alone	0.72	0.76

Clearly, exercise had a benefit on the all-cause death rate, showing an additional 15% reduction over no exercise (RRs of 0.87 vs. 0.72). The effect of exercise on repeat heart attack risk was variable; counseling plus exercise had an additional 24% benefit over counseling alone, but exercise alone only increased the additional benefit by 10% over counseling alone.

The mortality results were even more pronounced two years after starting an exercise program. There was nearly a 50% reduction in deaths after a first heart attack, compared with people not entering a rehab program.

The bottom line

Cardiac rehab programs that emphasize risk factor changes (lipid-lowering, blood pressure control, stopping smoking, a heart-healthy diet) all help lower the death rate and the risk of a repeat heart attack, regardless of whether the program includes an exercise component.

Patients obviously need to be encouraged to take part, as most programs are financially supported by healthcare organizations, and they don't carry any risks to the participant - quite the reverse.

Source

• Meta-analysis: Secondary prevention programs for patients with coronary artery disease. CAM. Clark , HL. Hartling , VB. Vandrmeer , MA. McAlister , Ann Intern Med, 2005, vol. 143, pp. 659--672

Related Links
Rehabilitation has big impact on heart attack survival
Mayo Clinic: Cardiac Rehabilitation
American Heart Association: Cardiac Rehab

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