Patients who undergo an angioplasty and possibly the placement of stents have a much higher chance of survival if they received structured follow-up care, such as a cardiac rehabilitation program, researchers from The Mayo Clinic reported in the journal Circulation: Journal of the American Heart Association.
After analyzing 14 years’ worth of data, the authors found that mortality from all causes was reduced by 46% in angioplasty patients who took part in cardiac rehabilitation.
Randal Thomas, M.D., M.S. and team gathered data from a Mayo Clinic registry on patients who had been treated with PCI (percutaneous coronary interventions), in other words angioplasty. They also followed up by telephone and worked out the outcomes of nearly 2,400 patients.
In PCI, also known as PTCA (percutaneous transluminal coronary) or angioplasty, a balloon-tipped catheter is used to enlarge a narrowing in a coronary artery. The balloon is inflated when next to a plaque in the artery, and flattens it against the vessel wall. Often a stent (metal-mesh tube) is inserted to stop the vessel from collapsing.
40% of the 2,400 patients took part in at least one cardiac rehabilitation program session (average 13.5 sessions). These programs are known to improve survival after heart attacks, they also help patients alter their lifestyles which improves their outcome.
Dr. Thomas said:
“Our findings show that patients who participate in cardiac rehabilitation following PCI have better long-term survival – about 50 percent better – than those who don’t participate in cardiac rehabilitation.”
They factored in variables which can impact their calculations, such as cholesterol levels, family history, some medical conditions, BMI (body mass index) and smoking status. They registered death rates starting at one year of follow-up. Improvements were found among both sexes, all age groups and among those who received elective or non-elective PCIs.
503 patients died during the follow-up period, of which 199 were cardiac-related. Nearly 400 patients went on to have a heart attack while 755 underwent further procedures to unblock blood vessels.
The authors stress that PCI, although a vital procedure, is not a heart disease cure. Ongoing rehabilitation programs and other interventions after PCI can have a major impact on patients’ life expectancy as well as quality of life.
Cardiac rehabilitation programs include:
- Advice on nutrition
- Help with quitting smoking
- Medical evaluations
- Patient education
- Personalized and monitored exercise training
- Therapy to control body weight
“Cardiac rehabilitation programs are effective at improving recovery, quality of life and long-term survival because they help deliver the lifestyle and medication therapies that have been shown to slow or even reverse the process of heart disease.”
Most of the patients studied were Caucasian. However, the authors write that their results are consistent with other studies of cardiac rehabilitation. Thomas added that further studies should be carried out to confirm these findings in other patient populations.
The American Heart Association informs that over 600,000 PCIs are performed each year in the USA.
Even if the current findings overestimate the benefits of cardiac rehabilitation – something Thomas says is unlikely – a mortality reduction of just 20%, instead of 46% would still be substantial.
The majority of insurance companies in the USA provide coverage for up to 36 cardiac rehabilitation sessions after PCI, heart attack and some other heart diseases. Medicare usually covers 80% of costs.
Kashish Goel, MBBS; Ryan J. Lennon, MS; R. Thomas Tilbury, MD; Ray W. Squires, PhD Randal J. Thomas, MD, MS
Circulation 2011; DOI: 10.1161/CIRCULATIONAHA.110.983536.
Written by Christian Nordqvist