Cardiac Rehab After Heart Attack

If I tried to make a list of all my patients who have had a heart attack in the past year, unfortunately I probably would be here awhile. We are NOT good at identifying patients at risk, and many patients refuse treatments and lifestyle changes that are proven to reduce their risk of a heart attack.

AFTER a heart attack, though, we have a very good idea what will reduce the risk of having another one. Sadly, only a very small number of patients take advantage of one of the best measures to reduce the risk of an encore performance: cardiac rehab.

Cardiac rehab consists of 36 one-hour sessions which are covered by Medicare and most if not all commercial insurance. The sessions include

  • supervised exercise training
  • counseling on diet
  • counseling on stress management
  • smoking cessation (if needed)
  • guidance on other measures for heart-healthy living

Researchers at the CDC in Atlanta looked at heart attack and heart failure patients covered by Medicare and found that only 24% of the patients even started cardiac rehab. Of those, on average patients completed only 25 sessions, with only 27% attending the recommended 36 sessions.

Older patients, patients of color, sicker patients and women were less likely to go to cardiac rehab. The study wasn’t designed to figure out why this was seen. However, I can imagine transportation and family support may have been a problem with the older and sicker patients. Access to care is always a problem with patients of color and in this instance doesn’t surprise me. Women in general put their own needs last, and I can definitely see female patients being less likely to attend an extended series of rehab sessions. I can’t even get them to go to 12 physical therapy sessions to address an excruciating musculoskeletal injury!

Cardiac rehab reduces the risk of death in the period after a heart attack. It improves quality of life, mood and functional status. It also reduces the risk of hospital readmission. Every patient with a heart-related hospital stay should be offered (and should take advantage of) cardiac rehab.

If you or a family member find yourself diagnosed with a heart condition, ask your cardiologist or family doctor whether you qualify for cardiac rehab. If you do, GO. Go to ALL the sessions, go until they tell you not to come back anymore. Your heart will thank you!

QUESTION: Did you know about cardiac rehab? Do you know anyone who would benefit from it?

Share

Setting Goals For The New Year

Happy New Year everyone! Now comes the time of full parking lots at the gym and having to wait for equipment. Diet products are everywhere. Planners are selling out at the bookstore.

By February it seems like things are back to “normal” at the gym and elsewhere. Why does setting goals and meeting them seem like such a hard thing?

Generally there are three reasons why people don’t meet the goals they have set for themselves:

  • The goal is too vague: “I’m going to get healthier.”
  • The goal is too big: “I’m going to lose 100 pounds this year.”
  • No accountability

In management circles there is talk of setting SMART goals. SMART is an acronym that helps with effective goal setting. Goals should be

  • Specific
  • Measurable
  • Achievable
  • Relevant and
  • Time-limited

There are lots of resources to dive deeper into each of these characteristics but let’s start with our vague “I’m going to get healthier” goal from earlier. What would that mean? What does “healthier” mean?

In this case let’s imagine a diabetic patient. For him, “healthier” may mean getting better control of his blood sugar. If he is starting with a hemoglobin A1C of 8, he may set a goal of 6.5 in 6 months. This goal is specific, measurable, definitely achievable, relevant and time-limited.

If this were my patient, I would push him to make more goals to flesh out the plan. What is his food goal? What about an activity goal? Hopefully he already has taking his medication daily under control, LOL! After all, a dream with a plan (and a deadline, per Napoleon Hill) is a goal. The plan is important. How are we going to achieve this goal?

Once you have a goal and have broken it down into smaller pieces, it’s important to share the goal with someone who can support you. A spouse, a friend, a sibling, we need to have an accountability partner to remind you why you set the goal in the first place and pick you up when your motivation fizzles.

It doesn’t matter what your specific goal is. You can rock it this year!

QUESTION: What goals do you have? How can we make 2020 your healthiest year ever?

Share