Cardiac rehabilitation saves lives but is underutilized

Last summer Ted D’Esposito, a retired charter fishing boat captain, wasn’t feeling right. He was short of breath and his energy level was way down. He noticed a burning sensation on the back of his throat.

Diagnosed with coronary artery disease, the Islamorada resident had a stent placed in one of his arteries to restore blood flow to the heart. Though his stay at South Miami Hospital was only overnight, his recovery was far from over.

D’Esposito, now 66, began cardiac rehabilitation at Mariners Hospital’s Wellness Center a few weeks later and he considers it a blessing. “I feel like I’m 40 again,’’ he said.

Cardiac rehab, a supervised, comprehensive program of exercise, nutrition and lifestyle modification, is often prescribed to patients who have had heart surgery or a major cardiac problem. It is credited for preventing further coronary issues and helping patients change unhealthy habits.

D’Esposito, for example, lost more than 25 pounds and about four inches off his waist. He gave up carbs and added exercise to his daily routine. All this happened, he added, because he got off on the right footing when he was recovering from the stent procedure.

“There’s someone there with you helping you along, so it’s very reassuring,’’ he said. “You don’t worry that you’re going to overdo it."

The typical cardiac rehabilitation program offered at area hospitals lasts 12 weeks and includes twice or thrice-a-week exercise sessions, meetings with a nutritionist and other healthcare specialists, including physical and occupational therapists, psychologist or psychiatrist and, of course, a cardiologist. The goal is to help patients maximize cardiac function as well as reverse their symptoms.

A patient’s ability and functionality are assessed at the beginning of the program. Under the supervision of an exercise physiologist and the help of monitoring devices to keep track of various vital signs, a progressive exercise program is designed for each person, with the hopes of building fitness and strength — as well as lifelong exercise habits.

There are also nutrition and smoking cessation classes, counseling on a patient’s specific heart condition and sessions that educate a patient about stress and anxiety management.

“It’s really a way of teaching the patient how to change their lifestyle and should be considered part of treatment just like taking medicine,” said Dr. Harry Aldrich, chief of cardiovascular services and medical director of the Echocardiography and Stress/EKG Lab at South Miami Hospital. “Completing the program helps patients live longer and healthier.’’

Unfortunately, cardiac rehab is not prescribed nearly enough as it should. National studies show that only about 30 percent of eligible patients attend a cardiac rehab program, even as more hospitals offer them and cardiologists tout the advantages of monitored exercise, lifestyle improvements and controlling heart-related risk factors.

“It’s been around for a while, but there’s still a lack of awareness from the public at large,” said Dr. Sharon Andrade-Bucknor, medical director of cardiac rehab at the University of Miami Hospital. “There are also a lot of physicians who don’t even know who might qualify for such a program and are therefore not making the referrals.”

Most insurances cover 36 sessions of cardiac rehab for most heart conditions or cardiac procedures, including patients who have had heart surgery, heart attacks, stent placement, angina pectoris, balloon angioplasty, pacemaker and other coronary ailments. If cardiac rehab is not prescribed during a hospital stay, Andrade-Bucknor suggests a patient ask her doctor if she is a good candidate.

“Patients must play a role in their own healthcare and be informed of what is available,” she added.

Few people also take advantage of cardiac rehab because of a lack of insurance coverage or difficulty with transportation, since the program requires the patient to be at the hospital several times a week. In addition, rehab programs are particularly underutilized by older patients because of a misunderstanding of its benefits.

Some people, said Dr.Nirat Beohar, director of the cardiac catheterization lab at Mount Sinai Medical Center in Miami Beach, believe they are too old for such programs.

On the contrary, “older patients receive the same benefits as younger patients — a great improvement in their quality of life,” he said

Rehab programs also offer participants an informal support group of like-minded people. “It’s similar to A.A.,” Beohar added, referring to Alcoholics Anonymous. “It keeps people motivated to continue once they finish the program.”

For D’Esposito, cardiac rehab proved to be a life changer. His attitude about food and exercise — he had never been on a treadmill — has changed, as have his habits. Though he “graduated’’ from the Mariners Hospital program, he continues using its wellness center to exercise several times a week.

“I actually look forward to going,” he said. “It’s made me feel better, not just physically but also emotionally.”

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