Only 30 % of patients who have an eligible diagnosis for cardiac rehabilitation services actually attend. Of those that do attend there is a very solid trend in the United States that 70% are male, and 30% are female. Minorities are even less likely to attend.
There are many factors that contribute to the above statistics.
- Were you referred to cardiac rehabilitation?
- Do you have insurance that covers it?
- Is the co-pay too high to attend?
- Is the distance to the nearest facility too far a drive, or the cost of gas to expensive?
- Transportation issues – such as being able to safely drive yourself, or not having transportation?
- Do you feel like you are too young to attend or too old?
The lack of referral is an issue where it may be the physician has a pre percieved perception of what the services are. I ran into this issue frequently. Many healthcare providers percieve cardiac rehabiitation as a place for their patients to go and exercise. They often don’t realize the education that occurs. Exercise is important, but how about working with patients on learning a healthy diet, overcoming barriers to healthy lifestyles, tobacco cessation, support, risk factor education, stress management as a few examples of what one recieves in the rehabilitation setting. If your physician didn’t recommend it, it is ok to ask for a referral.
Insurance limits many, either they have a diagnosis that doesn’t cover it or the co-pays are exorbitant. I have seen co-pays of $100 per session. The programs can last up to 36 session so that can mean a pretty hefty out of pocket cost. Most patients won’t attend if their out of pocket for co pays are greater than $30 per session. Yes you get a lot from attending, but add that into the co-pays from the hospital, the physician bills, the medication costs, the lost work, the laboratory costs and it is a hefty out of pocket cost to have a heart event. Many patients experience complications requiring further testing, physician visits, medications making the cost even higher. It isn’t unusual for a patient to come to rehabilitation and tell me they received their bill for open heart surgery and it was $150,000, or a stent costing $30,000. The usually have a second episode of chest pain when they see the first bill.
How about travel? If you just had open heart surgery you probably are restricted from driving for 4 weeks, and then may not even feel healthy enough to drive self. Then you must rely on others two to three times per week to bring you to and from. Many rural areas do not have a public transport system that is reliable. Our bussing system might require you to spend 4-6 hours for transportation that is really only a 40 minute drive from the facility. Medicare will not cover telemed programs.
Why don’t women attend? Do they not feel comfortable thinking it is a gym? Do they have too many things on their plate to take care of themselves? Do they physicians not refer them, feeling they are already aware of what changes should be made or don’t think they would benefit?
There is no set age. In fact the younger the patient is the better in terms of making lifestyle changes and learning to cope with living with a chronic disease. Elderly people seem to benefit the most from the strength and conditioning as well as the social interactions. Our programs see people from ages 20- through their 90’s.
I think our Cardiac Rehabilitation programs do a poor job of catering to minority populations. When we study ethnically diverse regions we continue to note the same trends, it is primarily the white males that attend. Is this because we have few minorities staffing the programs. We teach with a cookbook approach, everyone is taught the same diet, the same stress management and lifestyle changes. Recently I was speaking to a group of Native Americans and they informed me that when we teach to a family it usually take seven generations for changes to take place. We certainly don’t address the spiritual needs or cultural differences. Do we teach how to modify the Arabic diet, or the African American diet? Can we effectively teach stress management if we don’t understand the family dynamics of different cultures? Nope most program don’t unfortunately.
I would love to hear from those of you with heart disease why you may have chose not to attend.
If you are considering attending here are a couple of valuable links to check out:
Cardiac Rehabilitation Fact Sheets
or for a Spanish version http://www.aacvpr.org/Portals/0/resources/patients/CRFactSheet_Spanishversion04.12.pdf
To find a program near you or to find patient resources: