Patient Concern: Cardiac Rehab Referrals Continue To Disappoint

By Adam Pick on September 22, 2010

From my own experience and patient research, I know that the physical, social and mental benefits of attending a good cardiac rehabilitation program are overwhelming. Unfortunately, physician referrals of these patient programs are… underwhelming.

 

Adam Pick At Cardiac Rehabilitation Center Me Peddling Away On The Bike At Cardiac Rehab

 

I’ve been disgruntled about this in the past. But, today I received an email from Karen which included an updated study from the Journal of the American College of Cardiology about cardiac rehab referrals.

Ready for the big finding of the study?

 

Currently, only 20% of cardiac patients who could benefit from cardiac rehabilitation are referred to outpatient rehabilitation facilities.

 

Needless to say, my eyes bulged when I read that statistic.

The referral rate was less than the last time I reviewed a similar study. Thankfully, I’m not alone in my disappointment.

“The gap in referral of patients to cardiac rehabilitation represents the largest gap in care for patients following a cardiac event,” said Randal J. Thomas, MD, of the Mayo Clinic in Rochester, Minnesota.

To enhance your recovery, I encourage patients and their caregivers to develop a complete and thoughtful approach to heart valve surgery. In my opinion, attending cardiac rehab should be a key ingredient of that approach.

For me, the moment I started cardiac rehab became the turning point in my recovery.

Being with the other patients and cardiac nurses helped me through several post-operative issues including chest pain and cardiac depression. That said, I really, really, really (emphasis added) hope you take the time to locate a cardiac rehab program prior to surgery.

Keep on tickin!
Adam


Written by Adam Pick
- Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.


Elle says on September 22nd, 2010 at 1:52 pm

I totally agree with Adam. I am a perfect example of one who was not able to get cardiac rehab. its been difficult in recovery and I have been fighting to get one. I did not have surgery at my hospital because they don’t have cardiac center so I had surgery at diff. hospital whom I heard had a great rehab program but after surgery I was told I could not attend unless I had $9,000 dollars because my hospital won’t pay for it. I’ve been searching since and I believe because of this lack of service I am not recovering as well as I should. Elle



Doug Watson says on September 22nd, 2010 at 2:26 pm

I was referred after my AVR however my insurance would not cover the rehab care. Having exercise capability at home, I chowe that path.

Doug



Geoff Stuart says on September 22nd, 2010 at 2:55 pm

I’m really scratching my head reading this. I 59 and had an AV replacement June 8 and there was never any doubt that either my surgeon or my cardiologist would write a scrip for rehab. I had my choice of hospital programs; why would you be limited to the hospital where you had the surgery? My docs’ only (joking) caveat was that I was in such good shape that I’d be bored in rehab. Well, I wasn’t. The staff at Paoli Hospital in Paoli, PA challenged me to the max and even wrote “Fantastic Athlete” in their case notes. Nobody ever called me that before! By the end of the 12 sessions, I had tripled the duration and intensity and weights from Session One and I was really glad to have done it. Have you all just tried calling your insurance company? I’m on Horizon of NJ BC/BS PPO plan and they did not bat an eye. The would have covered more than the initial 12 if I needed it.

Geoff

PS – Feeling great and this weekend I’m riding the MS Society 150-mile City-to-Shore bike ride. Minimally-invasive is the way to go!



Elle says on September 22nd, 2010 at 3:38 pm

thanks Geoff, yes that would be great if my hospital covered it. I was such a shock to me and I kinda got depressed during recovery. I did walks on my treadmill and around my neighborhood but I just hated the fact that I was not being monitored. They told me I was young and can bounce back, not true, doesnt matter the age in my opinion but the rehab after surgery. I have Kaiser so they don’t cover it unless my hospital has cardiac center. they wouldn’t refer me out. I had to speak with therapist who have experience as cardiac therapists to give me some advice on some exercises. its been such an uphill battle for me and now I feel my breathing and weight has been compromised. I am determined so thats been good for me. I am trying to do an exercise regime on my own to help myself. it is frustrating though. elle



Dale P. says on September 22nd, 2010 at 3:57 pm

I was actually discouraged from doing cardiac rehab by the surgical nurse — she said it was for old people (I was 59 and in no way do I consider myself an old person!) or for people who want group therapy. Fortunately, my cardiologist was behind it 100%. And I completely agree with Adam — my life, too, turned around once I started cardiac rehab. I’ve since been able to do things I’ve never done before in my life — like swimming a half mile!



Elle says on September 22nd, 2010 at 4:02 pm

wow, how i wish I had same support. its been pretty discouraging. I’ve been trying to find a cardiac rehab for myself since March of this year. Now its Sept. and I feel horrible. I have a hard time breathing and I’ve put on some weight – not very happy with care here but I work for Kaiser so its hard – there is a harrington act part of our insurance but its referral based and they won’t refer me to outside services. like I said it isn’t good. I believe that with cardiac therapy I can feel better. right now I’m on my own, its been depressing. e



Fran says on September 22nd, 2010 at 4:24 pm

This low number is shocking. Being on Medicare the sessions (36) are paid for partially and supplemental picks up the rest. So, I was fortunate to be able to attend. Since I’m in a-fib it was important for me to have the confidence to push myself. Being monitored made all the difference. I do believe patients need to be pro-active in their care and ask their doctor about rehab and not wait for the doctor to bring it up. Now 6 months post op after bovine mitral valve and tricuspid repair and doing really well.



John D. says on September 22nd, 2010 at 5:07 pm

Adam, Couldn’t agree more. Hartford Hospital has an outstanding Cardiac Rehab Program and a Caring Staff of dedicated professionals. My recovery was faster and safer using this controlled enviornment and progressive improvement. Should be covered by all insurance companies.



Carole Wiley says on September 22nd, 2010 at 5:42 pm

Aortic replacement done on June 11, 2010. My visits from the Visiting Nurse ended the end of July. I contacted the local Cardiac Rehabilitation Center within a week. Here it is September 22, 2010 and I am just getting my first evaluation appointment tomorrow. I think part of the problem with people not entering Cardiac Rehabilitation is that it takes so long to be admitted to a program.
When I inquired as to why the wait was so long, the answer I got was that several Cardiac Rehabilitation Centers had closed and the wait list at the remaining programs had become longer. I reside outside the metropolitan Boston area.



Charles W. Taylor says on September 22nd, 2010 at 7:07 pm

Adam: I continue to receive very helpful information from your book and your blog. I had AV replacement,October30,1909 at North Ms. Medical Center. Dr. David Talton was the surgeon. Dr. Talton wrote a script for cardiac rehab at Baptist Memorial Hospital Oxford,Ms without hesitation. Cardiac rehabilitation was certainly the turning point in my recovery. I am surprised that only 20% of cardiac surgery patients are referred for cardiac rehab. This seems to be a real flaw in the treatment protocol and failure to understand the importance of cardiac rehab in the recovery process.



Pat says on September 22nd, 2010 at 7:24 pm

My husband has AV replacement, mitral valve repair, and the Maze procedure. He was most disapointed in cardiac rehab being in good physical shape prior to the surgery. He read a book–at the suggestion of a friend who has completed several Ironman events–called “The Maffetone Method” by Phil Maffetone. It provide him a way to train his heart by keeping the heart rate relatively low over a lengthy period of time–something he found ideal for the period after surgery. After reading the book, which was written as a training method for any athelete, particularly triathletes, he wished he had had it during cardiac rehab ad there was little guidance or direction merely a watch on how he was doing while exercising. The method is easily monitored with a heart rate monitor. He still uses the basic method/formula today mixing it with intervals. It has been 10 months since his surgery and he is pleased with the results. We both ride road bikes and enjoy longer rides once a week, hopefully when our very hot weather starts to cool down. Good luck!



Raymond Burr says on September 22nd, 2010 at 9:23 pm

I had an aortic valve and part of my ascending aorta replace on July 1 at Sentara Heart Hospital in Norfolk, Va. about 110 miles from where I live and 3 weeks later on July 23 I started Cardiac
Rehab at Chippenham Medical Center in Richmond, Va. closer to where I live. I was fully monitored for the first 3 weeks (3 times a week), of rehab and then taken off the monitor because of my progress. I paid a $30 co-pay each time and my Insurance paid the rest. After I came off the monitor the fee droped to $5 each time and I only use a heart rate monitor and they check my BP before I start, half way thru my workout and after I cool down. Anthem Healthkeepers would have covered me up to 36 days of fully monitored exercise. Every Wed. they have a class where they cover subjects such as different blood pressure meds., diet, exercise (the why and the how), etc. Every couple weeks they increase my workout. I begin weight training on monday. On the days when I do not go to Rehab I either walk, ride my Nordic Trac ski machine, cut grass, or play golf for 45-60 minutes.

I’m a 63 year old retired Firefighter and at times I’ve been sort of an exercise freak. I know that not everyone is going to do the same things that I do, but I think that a Cardiac Rehab program is important and if a rehab center is not available or isn’t financially affordable it’s important to develope your own program, with the help and advice of your doctor. It may mean going to an indoor mall and walking for 30 minutes, 3 or 4 times a week or doing the same on a treadmill if you have one. You may not be able to monitor everything but you can buy relatively inexpensive heart rate monitors and automatic BP monitors to check your BP. Ask your doctor for lower and upper heart rate and BP levels to maintain during exercise.

This has been a fairly long reply but it’s something I feel strongly about and I think along with a positive attitude it has contributed greatly to my speady recovery (it’s been less than 3 months since my surgery and I feel great).



Elle says on September 22nd, 2010 at 11:33 pm

Thanks to all for your support. yes its so frustrating. I even called all the necessary #’s at kaiser and all the programs are gone which pertain to something close to a cardiac therapy program or even a group which meets after open heart surgery. I’ve called Kaiser’s health coach and so on, I feel like I am hitting a wall each time and they keep telling me I am young. I DONT THINK IT MATTERS that I AM YOUNG, I should still deserve and get proper therapy after such a surgery. All of you have confirmed my thoughts that I deserve to have one. I even asked for an exercise regimen and they just said keep walking. that just didn’t feel right with me. I am doing my best but I feel now that am a bit depressed and exhausted. thanks to all elle



George Trevor says on September 22nd, 2010 at 11:41 pm

Hard to believe that a cardiologist would not recommend cardiac rehab. It was never a question after my surgery for AVR on 2/16/10. I was in cardiac rehab 13 days after surgery. It is also disturbing that there seems to be insurance issues that prevent some people from access but I will not comment on the politics of that. One item that may be helpful is a heart monitor. The day before I was released from the hospital I could see that keeping track of heart rate was important. I had used heart monitors for years with my exercise program having worn out two Polar monitors. However, I knew that the typical Polar monitor would be difficult with the strap across the chest. I sent my wife to REI with instructions to find a wrist monitor. New Balance makes such a monitor using the same technology as an EKG. I have used mine for the past seven months and it is great. Was especially useful in the several weeks after surgery when I was not suppose to exceed a certain heart rate and with a touch I could see my heart rate. Cost is around $60 and well worth the price.



Riley McMinn says on September 23rd, 2010 at 10:46 am

[In response to Geoff and Elle’s Comments]
Contacting both the insurance company and hospital (precertification/insurance department) are other contacts to test trying to learn what the next step to finding a rehab center. Insurance payment for Cardiac Rehab may also depend on medical necessity or prior authorization although a precertification may not be required. Often a secondary insurance is needed to cut the cost. Also, try locating a Phase III/IV Healthplex or Wellness Center(Hospital based “gyms”) in your area.



Riley McMinn says on September 23rd, 2010 at 10:57 am

Elle, also try mendedhearts.org. It’s a nation-wide heart support group that may have a chapter in your area. Hope this helps.



Don Hull says on September 23rd, 2010 at 12:31 pm

I had Mitral Valve Replacement surgery in April, ’09 in Nashville which is two hours away from my home. My cardiologist set me up at the local hospital with the Cardiac Rehab folks. I thought I could do it for only 6 weeks, but he insisted I do it for the full 12 weeks, 3 days per week plus a one hour class each week. It was very good and BC/BS paid for it.

I too am surprised that the percentage of cardiac patients referred for rehab is so low.



Kathy J says on September 23rd, 2010 at 7:53 pm

I am grateful that my cardiologist referred me to rehab. I received some very good pointers about exercising correctly and even lost a few more pounds. What is frustrating for me though is that my insurance told the hospital AND me that it would be covered, and now they are denying coverage for my rehab because they say it’s not “medically necessary”! I have had my cardiologist write a letter for me to send to my insurance and I myself have written an appeal letter. Sigh… I would definitely recommend rehab.



Duane Hunt says on September 25th, 2010 at 7:25 am

Before my mitral valve repair in January 2010, I was a very active person, running 7 miles 2-3 times a week and working out at the gym another couple times. During my early recovery, I was a great walker but I wondered if I would ever get back to vigor. Cardiac rehab rebuilt in me the courage and the stamina to get my mojo back. Without it, I would have been fearful and apprehensive to push myself (safely). My exercise weight levels may not be as high at the gym yet, but I am back to running. Over the weeks I’ve built up to 6 miles, and this past week I ran 7 miles for the first time post-surgery. Go to rehab!



Wendy says on September 25th, 2010 at 10:24 pm

My husband had aortic root and valve replacement in April of this year. Mood is becoming more and more of an issue, his anger seems inappropriate and is very unlike him. Tonight I handed him a dry towel as he got out of the shower, this enraged him. I feel like he is overdoing, he runs his own business and gets too tired, but at times like this I can’t find any real reason for his irrational behavior. He is becoming more reclusive and overall has me worried about him. I have tried to get him to talk to his do



Lucy Grubbs says on September 30th, 2010 at 11:35 am

I AGREE with you! Thanks to reading your book, after my AVR last November i asked for cardiac rehab. I was 45 at the time. The cardiologist didn’t think I needed it but for peace of mind i told him. It was sooo helpful mentally! Knowing what I was feeling was OK and to commiserate about my little twinges and that “yes” i would be ok. Had I not known about asking for rehab I would not have been given it. i still participate once in a while, its a great group of people I met. Yes I am the youngest and the only woman, but it is really something I needed mentally to get me back slowly to the gym.



Mary Ferraro says on September 30th, 2010 at 9:12 pm

Cardiac rehab is a “no brainer” if anybody was to ask me. I believe if insurance companies required it, they would be saving money. Exercise is the fountain of youth. Cardiac rehab helped me in an odd sort of way in addition to all the usual benefits. The staff there let me know it was within the range of normal to feel really grumpy from the post-op shoulder pain I experienced months after my valve repair. They also encouraged me to go to an orthopedist who then sent me to rehab which was wonderful.



Riley McMinn says on October 1st, 2010 at 11:02 am

Wendy, try finding a Mended Hearts group in your area. It is a heart support group for patients and families of cardiac surgeries. They may be able to help. Also, a change in diet, mood, and “usual” behavior is normal due to the heart-lung pump machine.



frank says on October 21st, 2010 at 4:36 pm

I had av and ascending artery surgery done 4/28/2010. That date was also my 70th birthday. After 10 days in the hospital, I returned home. A home nurse visted 3 times day for about 2 weeks. I declined rehab. I am very active and I have an exercise room with a variety of equipment. I started golfing in june just using 3 clubs and walking 18 holes on a hill course. In sept I starting using all to club and an electric walking cart. My buddies and I play 3 or 4 times and walk 18 holes. So far my recovery is going well. I have a mech valve so coumadin is part of the recovery. My level is stable and I am tested once a month. Hopefully the time can be extended. I am due for an echo but do not need a stress test for now.



Merilee Brown says on January 4th, 2011 at 4:20 pm

I had aortic valve replacement on October 27, 2010. I am 64 year old female. I would love to do cardiac rehab for the more rapid recovery. I have found it to be so expensive that I can’t manage it with my insurance paying a good percentage.
I would love to be able to find a cardiac therapist to work with to just keep me headed in the right direction without a formal program in a hospital. There should be some more affordable alternatives.
I have been walking regularly and I can easily do an hour at a time. I don’t think I am overdoing it and I started out slowly.
I am joining a local gym for the variety of equipment to use and to take away any excuse for bad weather. And I hope to add water exercise at some point.
I appreciate the information in these blogs. It is very helpful.


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