A treatment that reduces death after a heart attack, and two thirds of patients never get it

Cardiac rehabilitation is a comprehensive secondary prevention programme
for people recovering from a cardiac event or procedure. An optimal course is
36 one-hour sessions, combining:

• Team-based supervised exercise training
• Education and skills development for heart-healthy living
• Counselling on stress and other psychosocial factors

What it achieves

Participation **reduces the risk of death from any cause and from cardiac
causes**, and decreases hospital readmissions. It also improves
functional status, quality of life, mood, and medication adherence.

That is a strong result for an intervention with no pharmacology in it, and it
is why cardiac rehab appears in guidelines for:

• Having had a heart attack
• Stable angina
• Having received a stent or angioplasty
• Heart failure with reduced ejection fraction
• Having undergone **bypass, valve, or heart or heart-lung transplant
  surgery**

And almost nobody goes

Participation ranges from 19% to 34% in a national analysis, with strong
state-by-state variation and differences by cardiac diagnosis.

Between two thirds and four fifths of eligible patients do not take up a
treatment that reduces their chance of dying.

The barrier that is not the one people assume

Cardiac rehab services are widely covered by public and private plans —
so the obstacle is not coverage. It is that **co-pays per session represent a
financial obstacle for most participants**.

Thirty-six sessions means thirty-six co-pays. A charge that looks trivial per
visit becomes a substantial sum across a full course, and it falls on someone
who has just been through a cardiac event and may not be working.

Improving awareness, increasing referral of eligible patients, and reducing
system and patient barriers are all named as critical. And the closing
observation is the sharp one: **effective remedies have been identified but
are not being widely and systematically implemented.**

Source: Million Hearts®, Centers for Disease Control and Prevention.