Could Your Patient Benefit from Cardiac Rehab?
February 16, 2022
UH Harrington Heart & Vascular Institute expert working in many channels to get the word out about this vital service for patients with cardiovascular disease
UH Clinical Update | Winter | 2022
Cardiac rehabilitation is unquestionably effective. According to data from the Million Hearts initiative spearheaded by the Centers for Disease Control (CDC) and the Centers for Medicare & Medicaid Services (CMS), people who attend all 36 sessions of a typical cardiac rehab program have a 47 percent lower risk of death and a 31 percent lower risk of heart attack than do people who attend only one session. What’s more, data from meta-analyses of randomized-controlled trials show that participation in cardiac rehab results in decreases in overall and cardiac mortality as well as improvements in functional capacity, physical and psychological function.
“Cardiac rehabilitation is unquestionably a good service that makes people feel better, makes people live longer and probably cuts down on recurrent heart attacks and hospital admissions,” says cardiologist Richard Josephson, MD, Medical Director of Cardiovascular and Pulmonary Rehabilitation at University Hospitals, based at UH Cleveland Medical Center. “But it’s under-utilized. It’s a multidisciplinary intervention, and some physicians are not as engaged as they should be.”
A 2020 study of cardiac rehabilitation participation among Medicare beneficiaries found a participation rate of 24.4%, with the lowest rates of participation among older patients, women, Hispanic and non-Hispanic Black patients and patients recovering from a myocardial infarction. One bright note: This participation rate reflected a 29% relative increase from similar data gathered in 1997.
However, Dr. Josephson says there’s still much room to improve. To that end, he has been working with several prominent national organizations in recent years to increase provider knowledge about the benefits and indications for cardiac rehab. In 2019, he worked at the invitation of the American College of Cardiology (ACC) to organize, develop and implement a first-of-its-kind, transformational series of free educational webinars. Still available on the ACC website, the series includes 15 modules grouped into five, one-hour sessions. Dual CME/MOC credit is available. They are available to all at no charge, although non-ACC members will need to create an ACC account. Dr. Josephson contributed three modules and solicited others from national experts in the field of cardiac rehab.
“The idea is to provide a didactic resource for physicians, to educate primarily cardiologists with real information for their patients who could benefit from cardiac rehab,” Dr. Josephson says. “There’s no other one, good, convenient location for physicians to learn this. How do you handle patients who have heart failure – not in general, but when they’re in rehab? What do you do with patients who have pacemakers and defibrillators? These webinars address those important issues.”
With today’s complex cardiovascular care, the need for a good working knowledge of cardiac rehab best practices has never been greater, Dr. Josephson says.
“In some ways, the patients are getting more complicated physiologically, with LVADs, heart transplants and some of the less common care given to these patients,” he says.
Viewers of the five cardiac rehab webinars produced by Dr. Josephson and the ACC will learn:
- Which patients are appropriate for cardiac rehabilitation referral and enrollment
- How to use exercise stress testing before cardiac rehabilitation to develop the exercise prescription and to evaluate improvement and return to work activities after cardiac rehabilitation
- How to construct an exercise prescription for most patients in Phase 2 cardiac rehabilitation
- How to tailor cardiac rehab for patients with systolic heart failure, LVADs, post-heart transplant or frailty
- How to develop an exercise prescription for patients with pacemakers, ICDs or recent valve procedures
- How to screen patients in cardiac rehabilitation for depression or anxiety, and how to motivate patients towards positive behavior change
- How to apply practical pharmacotherapy to enhance tobacco cessation in patients in cardiac rehabilitation
More recently, Dr. Josephson has been a key contributor to a webinar series hosted by the American Association of Cardiovascular & Pulmonary Rehabilitation. This five-webinar series covers:
- Using Medicare Rules to Build a Better Cardiac Rehabilitation Program
- Providing a Personalized Exercise Prescription for the Clinical Patient
- The Role of the Medical Director (presented by Dr. Josephson)
- Risk Factors: Prioritization and Resources
- Measuring and Tracking Outcomes to Improve Care
In addition. Dr. Josephson is guest editor of an upcoming special issue of the journal Progress in Cardiovascular Diseases devoted to cardiac rehab
“The theme is that UH is providing education in this field for colleagues around the world,” he says.
Dr. Josephson says he hopes these efforts will lead to more use of cardiac rehab services among the large and growing number of patients for whom it is indicated.
“Presently, cardiac rehab is the central intervention for effective secondary prevention of cardiovascular disease and optimization of the functional status for the legions of patients in the USA and elsewhere afflicted with cardiovascular disease,” he says. “The overall growth in population, the effectiveness of treatments that previously resulted in near immediate death, and the overall increasing lifespan have all contributed to substantial increases in the number and medical complexity of patients suitable for cardiac rehab.”