Why so few heart attack survivors take advantage of rehab?

A new reserach published in Circualtion has found, as in many other studies, that cardiac rehab improves the survival rate of heart attack survivors.

The study tracked more than 30,000 Medicare patients aged over 65 for 4 years and found that
those who completed 36 sessions of rehab had a risk reduction of 47% in death and 31% in heart attack than those who had fewer sessions. However only 18% attended all 36 sessions and drop-out rate was high.

Other studies have shown that patients who attended even a few sessions improved their survival rate significantly, but most heart attack survivors did not go to rehab and those who went did not stick to it. Why don't patients take advantage of it?

Some cardiologists say that successful rehab required strong self-discipline and perserverance as well as respect in the medical community supported by adequate resources. A study published in 2007 in Circualtion found that cardiac rehab was provided to about 14% of patients hospitalised for heart attacks and 31% who had bypass surgery.

Source: Bradley G. Hammill “Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries” Circulation. 2010;121:63-70 ( f/t via Athens)

Elderly should be offered hypertension drugs

Some previous studies have suggested that the over-80s may be harmed by the hypertension medication, but the Daily Mail reported that a major study by Imperial College London found the opposite.

The study looked at 3,845 patients from 13 countries with an average age of 83 and had high blood pressure and the use of one particular type of diuretic blood pressure medication. Within a year of treatment, there was a 21% reduction in death rates and 64% drop in heart failure, 39% drop in stroke deaths and 34% reduction in cardiovascular events.

Source:"Treatment of Hypertension in Patients 80 Years of Age or Older" New England J of Medicine. March 31, 2008 (10.1056/NEJMoa0801369)

Rethink preventive treatments in elderly people

Researchers from the UK and New Zealand said that "preventive treatments in elderly people may simply change the cause of death rather than prolonging life" in the article "Preventive health care in elderly people needs rethinking" in BMJ Online First.


As an example, they said that elderly patients will not necessarily reduce their risk of death caused by cardiovascular disease if they are given statins, their cause of death will most likely be "substituted" for cancer. Doctors are given financial incentives to persuading patients to accept such preventive treatments that are expensive and can be harmful to them.


The authors called for a more sophisticated model to assess preventive treatments in the elderly and concluded that cash may be better spent in relieving suffering through cataract, joint replacement operations and caring for people with dementia.

Health literacy linked to mortality risk in elderly

According to a study in the July 23 issue of Archives of Internal Medicine , "Health Literacy and Mortality Among Elderly Persons", David W. Baker et al, elderly patients who could not read physician's instructions or did not understand health information had a higher mortality rate than patients with adequate reading skills. Read the abstract.

The study found that inadequate health literacy was most strongly associated with death from cardiovascular disease and suggested communication with patients in plain language or using pictures or videos to explain complicated ideas can be used to reduce the high mortality rate associated with low health literacy. Read the press release.