Cardiovascular rehabilitation programs following heart attacks or surgeries should be considered an essential health service in every country, says York University Professor Sherry Grace, who is leading an international initiative to promote the low-cost, lifesaving programs.
Grace returned yesterday from the World Congress of Cardiology, held in Dubai, where she presented an International Charter on Cardiovascular Prevention and Rehabilitation. The document, created by scientists from several universities and cardiac rehabilitation associations, is endorsed by 10 cardiovascular organizations in high-income countries such as Canada, the United States and Britain, as well as middle-income countries such as India.
Cardiac rehabilitation is an outpatient chronic disease management program to which patients should be referred after a cardiac event or procedure. Each patient is assessed and managed by clinical staff, undergoes an exercise test and follows a four-to-six-month program of exercise, nutrition counselling and health education. While bypass surgery may cost $40,000 to $80,000, the cardiac rehab that should follow it costs only $1,500.
“The benefits of cardiac rehab are well established. There are over 11,000 patients tested in 40 trials performed around the world. The data shows 25 per cent lower death for patients who go to rehab versus those who don’t, as well as significant reductions in re-hospitalization,” says Grace.
“The magnitude of the benefit is similar to what patients see with aspirin and statins. Doctors always recommend those but they don’t always recommend cardiac rehab and that’s a shame,” adds Grace.
Cardiovascular disease remains the leading killer of adult men and women globally, so cardiac rehab programs could extend and improve millions of lives, says Grace. A professor of kinesiology and health science at York, Grace is also director of research into cardiovascular rehabilitation and prevention at the Peter Munk Cardiac Centre, University Health Network.
On average, about 30 per cent of Canadian patients are referred for cardiac rehab after a heart attack or surgery. Grace has developed strategies in the past few years to increase the number of Canadian heart patients being referred to cardiac rehab programs – as a result, in some hospitals in Ontario, the rate is as high as 85 per cent. In contrast, only about 20 per cent of middle- and low-income countries around the world have any sort of cardiac rehab at all, and only the elite can afford it, says Grace.
“We really do need to do more to promote the availability of cardiac rehab in these countries, considering that many middle-income countries now have full operating theatres to perform revascularization procedures,” says Grace. “If we can provide that acute care, which is quite expensive, certainly we can provide the low-cost care provided by cardiac rehab with similar benefits.”
The International Charter on Cardiovascular Prevention and Rehabilitation and the international effort to gain support for its call for action was funded through a knowledge-mobilization grant from the Canadian Institutes of Health Research.