Choose your own heart attack story

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cardiac rehabilitation

Adjunct Professor John G Kelly, AM

Group CEO, National Heart Foundation of Australia
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John joined the Heart Foundation in August 2016. Previous to that, he led sector reform for aged care as CEO of Aged and Community Services Australia. He has extensive clinical, management and consulting background in the health sector, including previous careers in law and in cardiac nursing and current academic appointments with the Sydney Nursing School and the University of Technology, Sydney.

Imagine for a moment that this is one of those choose-your-own adventure books. Except that it’s not a book – and the next choice you make could save your life. 

Let’s say you’ve just survived a heart attack and are recovering in hospital. You’re alive, which is a good start, but your world has been upended. You’re stressed, overwhelmed and frankly scared – though you might be trying not to show it. People keep giving you information and instructions, but you can’t take it all in.

One thing you do remember is your doctor telling you you’re “fixed” now (you think that’s what they said) and in the confusion you cling to the information as if it’s a life raft.

All you want to do is to get home.

Except that now someone is telling you about a cardiac rehabilitation program. You might not even be sure what rehab is or why you need it. It all feels like too much information.

You don’t know it, but you’re already lucky.

Heart Foundation figures show that only 40 per cent of heart attack survivors are routinely advised to attend cardiac rehabilitation by hospital staff – a figure that we at the Heart Foundation are doing our best to increase significantly.

But right now you have a choice:

Option 1) After a good night’s sleep at home in your own bed, you sift through the events of recent days and remember the word, “rehabilitation”. You may still be unsure what it’s all about, but you think about your time in hospital and how much you don’t want to repeat it, and you dig out the brochure and make the phone call.

Congratulations. You are one of the estimated 30 per cent of cardiac patients who make it to rehab. For the next six to 10 weeks, you’ll take part in a professionally supervised program designed to help you not only to survive, but thrive, as you adjust to life after a heart attack or other related condition.

Your program might take various forms. Often it starts in hospital with information and education about your condition, medications and lifestyle changes, and continues when you go home. It might be run in a group or one-one-one; at a hospital, a community centre or a clinic; in person or over the phone or internet; sometimes at your own home.

The support may include physical activity, health education, counselling and strategies to help you manage the sorts of risk factors that got you here in the first place: blood pressure, cholesterol, diabetes and others. Staff will tell you what you need to know about your medicines. Staff will be there to support you if you find yourself feeling depressed or anxious.

Assuming you complete your program – and 86% of people do - you will be 40 per cent less likely to find yourself back in hospital with another unplanned heart problem, and 25 per cent less likely to die of another heart attack.

Option 2) You’ve been referred to a cardiac rehabilitation program. Maybe you planned to go, maybe you didn’t. Maybe you’re one of the 24 per cent of heart attack survivors who believe they don’t need rehab; or one of the 12 per cent who say they just don’t have the time. Whatever the reason, you find yourself back home trying to get on pretty much as before – business as usual.

What you probably don’t know is that your chance of having another heart attack has increased. Around 30% of heart attacks are repeat events. The best way to prevent another one is to attend a cardiac rehabilitation service. It’s an important part of your recovery journey.

Of course, your options in choose-your-own adventures – as in life – are limited by the available alternatives. In reality, the main reason given by cardiac patients for not attending rehab is that nobody told them they could or should. Clinicians also face information gaps and time limitations and often overlook that important conversation.

This is why, along with working to increase public awareness of cardiac rehabilitation and its benefits, the Heart Foundation is lobbying for a national, agreed set of Quality Indicators for Cardiac Rehabilitation to measure referral, attendance, completion and outcomes. I recently spoke about this issue in the opening address at the Annual Scientific Meeting of the Australian Cardiovascular Health and Rehabilitation Association (ACRA).

Having such indicators would make it easier for rehab services to collect consistent data about what is available and what works. The data could improve patient outcomes, inform development of best practice models and cut costs – currently $30,000 in healthcare for each heart attack patient, compared to an average of $885 to attend cardiac rehabilitation.

Surviving a heart attack is not the end of the story; it’s just the beginning. What would you choose?