Cardiac rehabilitation helps survival time in heart patients receiving stent therapy

The findings, presented at the annual meeting of the American College of Cardiology in Atlanta, found that patients who had coronary angioplasty (stent placement, also known as percutaneous coronary intervention) and afterwards participated in a cardiac rehabilitation program had a 45 to 47 percent decrease in mortality compared to those who did not participate in a cardiac rehabilitation program.

"Patients need to know that once they've had a coronary artery stent placed, they are not cured," says Randal Thomas, M.D., a preventive cardiologist at Mayo Clinic in Rochester, Minn. "Participation in a cardiac rehabilitation program will improve their health outcomes and quality of life."

The study is one of very few that has looked at mortality rates after coronary angioplasty. "No other studies have been able to include the clinical details we have included," says Dr. Thomas. The research team examined the records from a special database of 2,351 Mayo Clinic patients who underwent coronary angioplasty between 1994 and 2008. The overall participation rate in cardiac rehabilitation was 40 percent. Individual patients were followed for an average of six years.

In cardiac rehabilitation programs, patients exercise rigorously and get help in controlling risk factors. This leads to health benefits that are evident within the first year, and grow even larger over the long term, Dr. Thomas says.

Although cardiac rehabilitation programs are beneficial, Dr. Thomas says only 20 percent of all eligible cardiac patients nationally and 60 percent of Mayo patients participate. Several factors produce barriers to participation.

"Cardiac rehabilitation wasn't covered by insurance for patients undergoing angioplasty therapy until 2006," Dr. Thomas says. "Many patients and providers don't know that it's covered now. Also, some patients live far away from a cardiac rehabilitation facility. But what's most troubling is that physicians often fail to emphasize the need for cardiac rehabilitation with their patients."

"Cardiac rehabilitation is like a life raft to carry them (heart procedure patients) through the turbulent white water of cardiac trouble," Dr. Thomas says. "It's very important that they participate in such a program."

Collaboration

The study was funded by the Mayo Clinic Division of Cardiology. Co-authors include Kashish Goel, M.B.B.S.; Ryan Lennon; R. Thomas Tilbury, M.D.; and Ray Squires, Ph.D., all of Mayo Clinic.