The heart is a precious thing, reflected in the adage, “God gives you one, then you’re on your own.” Why, then, do extremely small numbers of patients turn out for cardiac rehabilitation programs after they’ve had a myocardial infarction? Do they mistakenly believe hospitals have drawers filled with off-the-shelf spare hearts ready for installation?

The likely explanation for this lack of participation, based on findings published recently in JAMA Internal Medicine, is that patients simply did not get the memo. That is to say, they do not understand the critical importance of cardiac rehab.

Who’s in, who’s out

“Participation in cardiac rehab remains disappointingly poor, despite widespread efforts to improve referrals,” Jacob Doll, MD, states in a report published by HealthDay. Doll, who is a fellow at the Duke Clinical Research Institute in Durham, NC, led the JAMA study.

Doll does not entirely blame poor referrals as the reason only one-third of patients who have suffered a heart attack actually attend a cardiac rehab program. Additional reasons, according to Doll’s research, include prohibitive cost, inconvenience, and poor access to transportation.

The JAMA study also reports those who most frequently ditch cardiac rehab are older adults. Younger patients who have fewer comorbidities are more likely to attend, according to the study. Older adults are also more likely to cite transportation as an obstacle in participating in a cardiac rehab program, according to Patrick O’Gara, MD, Brigham and Women’s Hospital, Boston. O’Gara is a cardiologist whose comments appeared in an editorial that accompanied Doll’s study, according to the HealthDay report.


O’Gara explains that many patients for whom cardiac rehab may be appropriate may find the programs overwhelming. This, he says, is due in part to the fact most programs call for a patient to participate in three sessions each week for 12 weeks.

“For some patients, that commitment is too disruptive or too inconvenient, and it may not be supported by their employer or their family,” O’Gara states in the HealthDay report.

Of the eligible patients referred to cardiac rehab during the study’s 3-year period, more than 62% were referred to cardiac rehab upon discharge, while only 33% of those patients complied with referral.

Participation can be improved in at least two ways, according to Doll and O’Gara. Both believe that home-based programs, especially those that leverage smartphone technology, offer an effective alternative. The other solution is simply to make sure patients understand the critical value of a cardiac rehab program.

O’Gara suggests that physicians should be sure to clearly explain the benefits of cardiac rehab, and refer patients to programs as close to home as possible.

 —Frank Long