In the months after a heart attack, those who stick most closely to their cardiac rehabilitation program are much more likely to be alive years later, a new study has found.

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Strict adherence to cardiac rehab guidelines can significantly improve a person’s survival chances after a heart attack.

After a person has had a heart attack, their care team routinely offer them cardiac rehabilitation. Rehab programs include advice on exercise, health education, medication, and lifestyle, in particular, quitting smoking, eating a healthful diet, and reducing stress levels.

In the first study to investigate the cumulative effect of sticking to multiple recommendations in cardiac rehab, researchers found significant benefits with every additional goal achieved.

The study identified that people who managed to meet all the recommendations had a mortality rate of up to 43% lower than the least conscientious.

This runs counter to the idea that there may be diminishing returns from cardiac rehab, with no additional improvement in survival once a person achieves a certain level of compliance.

The research appears in the Journal of the American Heart Association.

Scientists and doctors at Kaiser Permanente Northern California analyzed the medical notes of 25,778 people recorded 30 days after discharge from the hospital following a heart attack.

They repeated the study for 24,200 of these people who were still alive 90 days after discharge.

For each time point, the researchers checked whether the individuals were taking the following types of medication:

And also whether the people:

  • had a blood pressure reading lower than 140/90 millimeters (mm) of mercury (mm Hg)
  • were not smoking
  • had a low-density lipoprotein (LDL) cholesterol reading of under 100 milligrams per deciliter of blood (mg/dL). This measure was only included for those surviving 90 days after discharge to give time for the medication to have an effect

The researchers then correlated the data with patients’ subsequent survival, tracing them for an average of 2.8 years and a maximum of 7 years, depending on available records.

They found that every additional guideline a person met was associated with an 8–11% lower risk of death. Patients who met all the guidelines had a 39–43% lower risk compared with those who followed the fewest recommendations.

The findings reinforce the value of cardiac rehab programs and the importance of patients’ commitment to their recovery and leading a healthful lifestyle.

“While modern-day cardiac care may seem quick and simple — such as receiving medications and stents to clear a blockage — it’s still vital that patients take follow-up care seriously,” says lead author Dr. Matthew D. Solomon, a cardiologist with Kaiser Permanente in Oakland, CA.

“People often think they are ‘fixed’ after they are treated for a heart attack. But our findings show that following all the recommended treatments after a heart attack is critical to long-term health and wellness. Doctors and patients must work to ensure every single evidence-based recommendation is followed. Following ‘most’ of the recommended treatments is not enough.”

– Dr. Matthew D. Solomon

The authors concede that as an observational, retrospective study, their work had some limitations.

They were unable to ascertain the effectiveness of other important behavioral measures, such as improvements in diet and exercise, for increasing survival because these factors were not in the medical records.

Other unmeasured factors may have confounded their results. People who were generally more healthy at the start of the study may have found sticking to the guidelines easier, for example.

Also, because reliable death records were not always available, the researchers used figures for mortality from all causes in their analysis. This means that some people will likely have died from causes unrelated to their cardiovascular health.