Many women, and seniors, do not enter a rehab program after having a heart attack. Yet, participation in cardiac rehabilitation markedly lowers the risk of dying or having a second heart attack during the next three years, results of a recent study show

“Cardiac rehabilitation after a heart attack is underused, particularly in women and elderly individuals,” study author Dr. Veronique L. Roger of the Mayo Clinic in Rochester, Minnesota told Reuters Health. “It’s important that they make every effort to participate,” she said, citing its effectiveness in improving outcomes after a heart attack.

Cardiac rehabilitation is a tailored health care intervention offered to specific groups of patients, including those who have experienced heart attack. It involves medically supervised exercise sessions, as well as education and counseling sessions about stress management and making lifestyle changes.

Such outpatient programs are becoming more important as patients spend less time in hospitals after a heart attack and other major events.

Roger and her colleagues investigated heart attack patients’ participation in cardiac rehabilitation and the association between their participation and later survival.

They found that among 1,821 men and women from Olmsted County, Minnesota who experienced a heart attack between 1982 and 1998, 55 percent opted to participate in an outpatient cardiac rehabilitation program.

Women were 55 percent less likely than men to participate in rehabilitation, and older study patients were less likely to participate than younger participants, Roger and her colleagues report in the Journal of the American College of Cardiology.

For example, only 32 percent of men and women aged 70 years or older participated in cardiac rehabilitation, in comparison to 66 percent of 60- to-69-year-olds and 81 percent of those under the age of 60.

After nearly seven years of follow up, 774 people died and 493 experienced another heart attack, the report indicates. Men and women who participated in the rehabilitation program, however, had a 56 percent lower risk of death and a 28 percent reduced risk of experiencing another heart attack within three years after the attack.

Altogether, 95 percent of program participants survived three years after experiencing a heart attack in comparison to 64 percent of non-participants.

In fact, “On average, for patients who participated in cardiac rehab, it was almost as if the heart attack never had happened,” Roger said in a statement. “They had the same three-year survival as what would be expected from area residents of the same age and sex who had not suffered heart attacks.”

The current research did not address why women and elderly individuals may be less likely to participate in cardiac rehabilitation, but Roger speculates it may have something to do with “perceptions about the risk of heart disease in women versus men.” Heart disease is the number one killer of women, but breast cancer usually gets the most attention, she explained.

Describing effective health care delivery as a “two-way street,” Roger said health care providers can offer cardiac rehabilitation, but they cannot force their patients to participate. Patients should “be on the alert for it,” and take advantage of the opportunity to participate, she said.

Cardiac rehabilitation is an effective intervention, Roger added, but it requires a commitment from patients, who must invest time and other resources to attend the sessions offered and gain the greatest benefit.

SOURCE: Journal of the American College of Cardiology, September 1, 2004.