Washington, DC - A majority of heart attack survivors do not receive appropriate care and counseling, with less than one third of patients participating in cardiac rehabilitation services, a US survey found. The data on post-MI rehabilitation services in 19 US states and the District of Columbia appeared in the November 7, 2003 issue of the Morbidity and Mortality Weekly Report.1

Although cardiac rehabilitation, including the management of cholesterol and lipid levels, hypertension, diabetes, and weight, as well as counseling on diet, physical activity, and smoking cessation, is key to reducing cardiac risk factors and improving survival rates post-MI, many eligible patients do not seize the opportunity to participate in such programs. To determine the actual rate of participation in cardiac rehabilitation, the Centers for Disease Control and Prevention (CDC) has analyzed data from the Behavioral Risk Factor Surveillance System, a telephone survey of 65253 people in 19 states and Washington, DC. The report, by Dr C Ayala (National Center for Chronic Disease Prevention and Health Promotion, CDC) et al, says that in 2001, 4% of those interviewed reported having ever suffered an MI. Only 30% of them said they were in cardiac rehabilitation after the event.

Men, persons aged 50 to 64, and those with higher education levels were more likely than other MI survivors to have received cardiac care and counseling. After adjustment for sex, age, and education level, cardiac care receivers were more likely than nonreceivers to report high cholesterol levels and regular aspirin intake, to be physically active, and to have been counseled to maintain a cardioprotective diet.

An editorial note addressed several limitations of the survey: because it was restricted to heart-attack survivors not residing in long-term care facilities in only 19 states and DC, the findings may not be representative of the US population. Further, disease severity, which was not recorded, could play a role in the differences in cardiac rehabilitation rates, and self-reported health data can always be subject to bias. However, the low rate of MI survivors receiving cardiac rehabilitation services calls for public health efforts to help more patients to obtain such important care and counseling, according to the report, including:

Insurance plans that increasingly cover cardiac rehabilitation.

Updated guidelines for physicians.

Assessment of patients' participation in the services offered.

A reminder system for patients to improve compliance.

Better education for MI survivors in cardiac rehabilitation.

Further studies, Ayala et al suggest, should "identify factors that improve participation and adherence to lifestyle modifications prescribed in cardiac rehabilitation."