Even with the focus on COVID-19, heart disease continues to be a major health concern. Many individuals have neglected their cardiac health during the pandemic, resulting in a decline in their quality of life. If you’re sitting on the couch with a bag of chips, you might be part of this group. Cardiac rehabilitation can help reduce these issues, but only 10 to 25 percent of heart patients utilize it. Awareness and doctor referrals are crucial, but systemic strategies are needed to increase patient access to these vital programs.
As someone who has researched cardiac rehab for 20 years, I work alongside the preventive cardiology community to expand patient access. Heart diseases are chronic and incurable, often leading to more cardiac complications, like hospital readmissions or the need for a stent—a small tube placed in a heart vessel to ensure blood flow. However, these risks can be significantly reduced through affordable, comprehensive cardiac rehab. This is an outpatient program that provides regular sessions over several months. It includes structured exercise, patient education, and counseling on lifestyle and psychosocial aspects such as stress and anxiety. Imagine it as a comprehensive program offering all the recommended strategies to reduce heart disease risk, coordinated with both acute and primary care providers. We link patients to resources that help them thrive. Our medical director emphasizes that cardiac rehab is “not just broccoli and running shoes” because participating reduces mortality and hospitalization by over 20 percent, improves well-being, and aids in returning to normal life roles. Yet, few heart patients receive this rehab, while more than 80 percent of other heart care recommendations, like medication, are adopted. Research in the cardiac rehab community has identified solutions including innovative health payment models, automatic referrals, clinician training, and tech-based rehab.
Despite these findings, patients still lack needed support. In Canada and elsewhere, health providers can’t bill government systems for cardiac rehab like they can for stents or cardiologist visits, even though clinical guidelines recommend rehab. We advocate for reimbursement or innovative payment options to make providing cardiac rehab financially viable, ensuring enough spots for all patients. For instance, bundled payments could cover both procedures like stents and the following rehabilitation, similar to current models for hip and knee surgeries in Ontario. However, we’re still waiting for heart procedure coverage as planned. As a cardiac rehab advocate, I often hear that heart risks are lifestyle-related, questioning if government-funded systems should influence individual health behavior. Yet, evidence shows cardiac rehab is cost-effective, leads to earlier work return, and reduces costly hospital visits and deaths. Unhealthy habits underlying heart disease also relate to cancer, but we don’t fault cancer patients for their condition. Lack of public policies ensuring access to safe exercise spaces, healthy food, clean air, and better tobacco control contribute to heart disease, highlighting that governments should aid lifestyle changes.
People need guidance to manage their health and modify multiple behaviors, addressing psychosocial issues impacting health outcomes. Leveraging electronic health records can streamline rehab referrals for post-procedure patients, exponentially increasing usage when coupled with clinician encouragement. Further, technology can expand rehab reach to all who need it. Though rehab usage hovers at 10 to 25 percent on average, it’s even lower among certain groups like women and rural or racialized communities, particularly concerning given heart disease’s epidemic status in low-income countries shifting from infectious to chronic conditions. In many middle-income nations, cardiology advancements favor stent placement over affordable cardiac rehab, which offers equal or greater benefits. Doctors often choose interventional cardiology over preventive care for financial reasons, limiting available rehab clinicians. Global efforts are increasing professional training for cardiac rehab delivery to prevent modern systems from prioritizing acute over chronic and preventive care seen in high-income nations.