CORVALLIS - Oregonians with heart disease who participated in a cardiac rehabilitation program cut their risk for a future heart attack in half, a new Oregon State University study concludes, but fewer than one out of six patients nationally choose to make these types of lifestyle changes.
The one year, $20,000 study documented the remarkable effectiveness of a cardiac rehab program at Good Samaritan Hospital in Corvallis, which is similar to other programs like it around the nation. But researchers say such programs are too seldom recommended by doctors, fully covered by insurance programs or taken advantage of by millions of Americans who live with coronary artery disease.
"About two thirds of all heart attacks are not fatal," said Dan Williams, an OSU assistant professor of exercise and sport science, and expert in coronary disease prevention. "So we spend over $30 billion in the U.S. every year to clinically manage or treat millions of people who have recurring heart attacks, strokes and other costly problems, often with hugely expensive medical procedures."
By comparison, Williams said, cardiac rehabilitation programs are comparatively inexpensive - the one in Corvallis, Ore., charges patients only about $500 to help them develop an individualized, appropriate regimen of exercise, diet, smoking cessation, weight reduction, stress management and drug therapy. And for the price of a TV set many patients can literally get a new lease on life.
In his study of people who began a cardiac rehab program, Williams found that after three months they had increased their circulating "good" HDL cholesterol by 9 percent, reduced circulating fats or triglycerides by 16 percent and "bad" LDL cholesterol by 13 percent. The program reduced by 19 percent the severity of a pre-diabetic condition that can often be a precursor to diabetes and heart disease, reduced abdominal obesity, and lessened the symptoms of depression that patients reported.
And overall, it cut their risk for a future heart attack in half.
The research was assisted by Kerri Eason, a registered nurse with Good Samaritan Hospital, and Jessica Jacks, an OSU research assistant. It was supported by the John C. Erkkila, M.D., Endowment for Health and Human Performance.
"Our findings are consistent with other studies done nationally which showed a 44 percent reduction in coronary-related hospitalizations after four or five years for people who participated in cardiac rehabilitation programs," Williams said.
"But in some areas of the country as few as 11 percent of the patients who could benefit from such a program actually participate in one."
On a national basis, Williams said, rehabilitation and wellness programs are often not supported by health insurance plans, even though people who don't receive such care often end up needing far more costly types of medical treatments, such as coronary artery bypass and balloon angioplasty. And some physicians, he said, still don't strongly enough encourage or refer all of their at-risk patients to participate, despite the growing evidence of the efficacy of the programs.
Further research is needed, Williams said, to document the cost-effectiveness of these types of programs. Early studies indicate the most favorable cost-benefit ratios are obtained by people who are the most severely ill, he said.