How many cardiac patients would use a prescription that solves multiple problems? Not many, Murray Low has discovered.
Low estimates that local hospitals discharge 10,000 heart patients a year but only about 2,000 get rehab. About 90 percent take medications: aspirin, statins, beta-blockers and ACE inhibitors.
That doesn’t make sense to Low, program director of cardiac rehabilitation at Burke Rehabilitation Hospital in White Plains and Stamford Hospital.
Pills usually do one thing. They lower blood pressure, for instance, or control blood sugar. Cardiac rehab programs encourage patients to take those pills and also lower blood pressure, strengthen the heart, prevent injuries, change body composition, improve blood flow, lower depression, reduce costly re-hospitalizations and lead to longer lives.
“I challenge you to give me any pill that does all that,” Low said.
Numerous studies have demonstrated the effectiveness of cardiac rehab. A 2009 study compared 70,000 heart patients who got rehab and 70,000 who didn’t after they were discharged from hospitals. Patients were matched by the medications they took and by the procedures they underwent.
A year later, patients who went to 36 rehab sessions had 58 percent fewer deaths. Patients who only took statin medications had a 20 to 30 percent lower mortality.
After five years, rehab patients saw a 34 percent lower death rate. Patients who were 85 or older when they went to rehab had a 19 percent reduction in mortality compared with those who never went.
“This study shook the tree,” Low said. “We used to think that by 85, why not leave well enough alone? Live out your years. The key message was, it’s never too late.”
Low received a Doctor of Education in Applied Physiology from Columbia University. The American Association of Cardiovascular & Pulmonary Rehabilitation named him as one of only 20 “masters of cardiac rehabilitation.” He lobbied Congress to pass a bill in 2009 that extended cardiac rehab services to Medicare patients.
“Evidence-based medicine is what it’s about,” he said. “It’s proving what works.”
When he started in the late 1960s, heart patients were kept in hospitals for a full month and confined to bed rest, a protocol that only weakened the heart.
Now, patients are expected to move: sit up the day after surgery, stand up the next day, then walk and then get discharged.
The next step, for those who get a physician referral, is rehab.
Besides Burke, Westchester County has cardiac rehab programs at Montefiore New Rochelle Hospital, New York-Presbyterian Lawrence Hospital, Northern Westchester Hospital and Phelps Hospital.
Patients go to rehab one hour a day, three times a week for 12 weeks. The program consists primarily of aerobic and strength-training exercises. They also get counseling on diet and nutrition, healthier lifestyles, weight loss, stress control, smoking and sleep.
A physician monitors patients electronically when they exercise. About every 875,000 hours of rehab, a patient experiences a cardiac event or dies.
“That’s about the same risk as walking out on the street,” Low said. “Safety is not the issue.”
After 12 weeks, patients are on their own but the exercises and habits they learned are still vital. Many of the rehab graduates participate in a fitness program at Burke. Everyone gets a home program, but Low encourages them to join a program that offers structure, support and socialization to motivate them for the rest of their lives.
But most cardiac patients do not go to rehab.
Some patients can’t take off from work or they don’t have a way to get to rehab.
Women, for reasons that are not fully understood, are less likely to get rehab. Yet, women who get rehab achieve an even greater reduction in mortality than men.
Medicare and most insurance plans pay for rehab, but high co-pays and deductibles deter patients, Low said.
But the greatest roadblock is the doctor. Nationally, only 20 to 30 percent of eligible patients are referred to cardiac rehabilitation.
It has taken a couple of decades for researchers to discover the benefits of exercise and for medical schools and doctors to appreciate the latest findings.
The challenge now, Low said, is to show health insurers that it is to their financial benefit to get patients in rehab and to educate more doctors about its effectiveness.
He also wants to cultivate relationships with large medical groups, and to encourage hospitals to automatically give patients referrals after heart procedures, as Stamford Hospital does.
“It’s frustrating not seeing better insurance support and better physician support,” Low said. “And it’s shameful.”