JACC: Cardiac rehab saves lives of elderly
Older cardiac patients benefit as much from cardiac rehab as their younger counterparts, according to a study published in the June 22 issue of the Journal of the American College of Cardiology.

In 2004, 7.2 million people died from coronary heart disease (CHD) globally, while in the U.S. more than 13 million people suffered from CHD and almost half a million died from heart disease in 2003. Moreover, Americans aged 65 and older account for more than 55 percent of heart attacks and 86 percent of CHD deaths.

"The good news is that patients who use cardiac rehab live longer than those who do not use it, regardless of their clinical diagnosis, gender, race, or socioeconomic background," said the study's lead author Jose Suaya, MD, visiting scholar at the Heller School for Social Policy and Management at Brandeis University in Waltham, Mass.

The study showed that "patients with different clinical backgrounds--heart attacks, coronary bypass operations, and even congestive heart failure--all had lower mortality when using cardiac rehab," Suaya asserted.

The study examined mortality in 601,099 Medicare beneficiaries who were hospitalized in 1997 for heart disease or CAGB and followed up through 2002. The study used three different statistical techniques to compare mortality between patients who used cardiac rehab and those who didn't. Overall, within a span of five years, mortality rates were 21 to 34 percent lower in older adult patients who used cardiac rehab. Cardiac rehab is a covered benefit under Medicare.

"Despite the significant benefits of cardiac rehab, only 12 percent of these patients actually took advantage of it," said Donald S. Shepard, PhD, a health economist at the Heller School for Social Policy and Management at Brandeis. The regimen typically includes aerobic exercise and lifestyle counseling to reduce cholesterol, weight and stress. The study found that patients who engaged in more than 24 sessions were an additional 19 percent less likely to die over five years than patients who used 24 sessions or fewer.

The findings are magnified among the extreme elderly and patients with other diseases, such as diabetes, on top of their heart disease. Researchers said that these patients were even less likely than others to participate, but those who did attend obtained especially large gains from cardiac rehab.

"This study should be a wake-up call to cardiac patients, their families and their physicians that cardiac rehab can extend life and improve the quality of life, even in older people," said William B. Stason, MD, senior scientist at the Heller School.

"The evidence is clear. Cardiac rehab saves lives but it is severely underused," noted study co-author Philip A. Ades, MD, professor of cardiology at the University of Vermont in Burlington.

"More coronary patients should use cardiac rehab. Perhaps one way to achieve this would be to require hospitals and physicians to report rates of referrals and use of this service as quality indicators of their performance," the authors concluded.

The Centers for Medicare & Medicaid Services (CMS) funded the study.