Brendan Trew felt out of place when he walked into the cardiac rehabilitation gym at his local hospital.
The 47-year-old considered himself fit and was one of the youngest patients in the room.
“I went on a 37-kilometre bike ride and then the following night I was having a heart attack,” said the single father from Hampton in Melbourne’s south-east.
But the six-week program – which involved a combination of exercise, education, and counselling – helped rebuild Trew’s strength and, more importantly, slashed his risk of having another heart attack and dying.
A new landmark study, published in the International Journal of Cardiology, found that attending cardiac rehabilitation programs reduced patients’ risk of dying from another heart attack by 75 per cent.
But the study of 7100 Victorian patients across 13 public hospitals found that only one in five eligible patients accessed these programs.
Lead author Dr Susie Cartledge, from Monash University, suspects patients are skipping the programs because advancements in medical technology have minimised the severity of their heart condition.
“If you have a heart stent put in now, it’s just a little wound on your radial artery,” Cartledge said, referring to the small incisions that have replaced many open-chest operations.
“Because the treatment is so minimally invasive, it actually minimises what has occurred for the patient. They think, ‘I’ve just got this little scratch on my wrist that healed in a week, I must be OK.’”
But Cartledge said heart disease, which leads to blocked arteries and stent procedures, is something patients need to manage for life.
“We are simply failing to get patients through the door,” she said. “If we could boost attendance to just 60 per cent, the health system would see massive financial savings, and thousands of families would be spared the tragedy of a preventable second attack.”
She said shorter hospital stays following heart procedures also meant patients found it overwhelming to process the information given to them at discharge. “We know patients only remember about one-fifth of what we tell them in the hospital,” said Cartledge.
“Then they get home, the sick leave finishes, they go back to work, and they fall right back into old habits – which is exactly what we don’t want.”
Patients attending cardiac rehabilitation benefited from lower mortality and fewer unplanned readmissions. These health benefits increased with every additional session they attended.
“Mortality was four times higher in those who didn’t attend any sessions compared to those who attended the full six-week program,” she said.
A typical program in Australia runs for six to eight weeks, and offers supervised cardio and strength training with health professionals and education. Counsellors help patients process the emotional impacts of suffering a cardiac event and facing their own mortality.
The programs are run in public and private hospitals and through community health services.
Trew initially dismissed his chest pain as reflux. But when the pain intensified, he decided to visit Sandringham Hospital’s emergency department.
He was then taken by ambulance to The Alfred and was told he had suffered a heart attack.
The news came as a shock. Trew had no risk factors for heart disease: he exercised regularly, ate reasonably well and had normal blood pressure and cholesterol levels.
He felt vulnerable when he was discharged from hospital two days later. He’d had a stent placed in his previously blocked coronary artery and had been put on medication to control his blood pressure and cholesterol.
“I had a heightened awareness of how frail we all are,” he recalled.
A counsellor at the cardiac rehabilitation program helped him work through these feelings, while an occupational therapist put in place strategies to help Trew ease back into his job in corporate sales.
He learnt about nutrition during education sessions, and realised that he was eating too much salt.
Cardiologist Kegan Moneghetti, who works at St Vincent’s Health, said cardiac rehabilitation programs helped patients make behavioural changes that had the same clinical powers as pharmaceutical drugs. This includes altering diets, committing to exercise and stopping smoking.
“Often these things are free and just take our time and our effort, but people need a structure and a support system to be able to achieve it,” Moneghetti said.
He said more funding was needed to ensure that patients could access cardiac rehabilitation programs soon after they were discharged from hospital. He said patients often faced a six to eight-week wait to access these programs.
“There is a small window where you can capture people to engage with change,” he said.
Cardiovascular disease is one of Australia’s leading causes of death and claims a life every 12 minutes, according to the Heart Foundation. About one in six Australian adults live with cardiovascular disease, which includes heart and blood vessel diseases such as coronary heart disease and stroke.
Most risk factors are preventable through a healthy diet, regular exercise and maintaining a healthy weight.
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Henrietta Cook is a senior reporter covering health for The Age. Henrietta joined The Age in 2012 and has previously covered state politics, education and consumer affairs.Connect via X, Facebook or email.
