The most under-diagnosed treatment when it comes to the heart

The main part of this post consists of 3 simple lists that you should go over. Although we have done an amazing job of treating heart attacks in the hospital, our attempt to prevent future heart attacks has been unsuccessful. This is due to the fact that people commonly think that once they have been treated in the hospital, they are healthy. This is far from the truth, and to understand why read this.

The most common misconception of those with heart problems, wether we are talking about heart attacks, Congestive Heart Failure (CHF), or arrhythmias, is that the heart needs to rest, and therefor people should not be exerting themselves. However this is far from the end. Once someone is diagnosed with a cardiovascular disease, a number of things can happen.

List #1 – What a person can go through after being diagnosed with heart disease:

  • Pain – This is a subjective measure, and even the diagnosis itself can largely increase the amount of pain that someone feels. This is directly connected to quality of life. 
  • Fear of sudden death – Anxiety greatly increases especially with respect to fear of death, both with heart attacks and other cardiac diagnoses. 
  • Fear of being handicapped – Suddenly they may feel largely restricted with the things they can and can’t do, and the rehab process is long and hard. Nothing can turn back the clock. 
  • Loss of control – This is true both physically, mentally and emotionally, life changes and that’s something that they need to get used to. 
  • Fear that won’t be able to go back to work – Everybody needs to make a living, and heart disease often comes too early in life to give up on work. Work is also a strong tool to keep people sharp, and feel important and relevant. 
  • Sexual dysfunction – One of the most common side effects of heart disease. 
  • Dependance on drugs all life – This can be a huge change especially for someone who isn’t used to taking medication. 
  • Lowering self worth – When people feel less relevant, they start to look at themselves as useless, and enjoy life far less. 
  • Lack of knowledge about the subject – People can often feel like don’t understand what’s going on in their body, and they often don’t. Not always doctors give the appropriate explanations and answers. 
  • Anxiety/depression – Depression is extremely common in those with heart disease, and is often overlooked due to the treatment which focuses largely on the heart itself, forgetting about the person around the heart. 
  • Physiological complications – The life of someone with heart disease changes drastically, from visits to the hospital, procedures, CHF, inability to do daily physical functions and unfortunately much, much more. 
  • Uncertainty of running to the hospital with every feeling in the chest – Chest pain can come from a number of things, including heartburn after food, breathing problems, and more. Someone after a heart attack might not know when they need to worry and when they don’t, everything makes them worry. 

The main point of cardiac rehabilitation is to relate to this entire list, physical and emotional problems in order to improve the quality of life, and prevent recurrent events. Even still, referrals to rehabilitation centres are often overlooked, and often when the patients are referred less than half actually make it. However, there is a lot of data proving that cardiac rehabilitation is beneficial in many ways.

List #2 – Proven benefits that are a result of cardiac rehabilitation:

  • Weight loss
  • Lower anxiety, and depression – Depression is one of the worst prognostic factors after MI
  • Slows down atherosclerosis – A heart attack is only the complication, the underlying disease is atherosclerosis which starts at the age of 16 and continues to progress our entire life, the question is how much does it progress and how fast.
  • Increases physical ability – Physical ability improves the quality of every day functioning, along with our ability to do physical activity. Physical activity as we know strengthens our immune system, increases happiness along with a long list of other benefits.
  • Improves the quality of life – In too many ways to list here.
  • Helps people quit smoking – This as well has too many attached benefits to list here.
  • Lowers the number of visits to the emergency room – Also lowers the number of times people are admitted to the hospital.
  • Lowers LDL (Bad cholesterol), and increases HDL (good cholesterol) – One of the hallmark measures of atherosclerosis
  • Improves Type II Diabetes – Lowers insulin resistance
  • Lowers blood pressure
  • Higher rate of return back to work – In addition to returning to work quicker, people who do cardiac rehabilitation programs also return to work in greater numbers than those who don’t.
  • Lowers death between 25-31%
  • Lowers the need for invasive procedures – Invasive procedures often has complications and risks, limiting the need for procedures is critical.
  • Saves money overall – Cardiac rehabilitation is cost effective, which means that it’s a win-win for insurance companies and patients alike.

I know what you’re now asking, what’s the third list? Well, cardiac rehabilitation is most commonly referred to after heart attack. However, this is not the only disease that can help! If you can benefit from cardiac rehabilitation, seek out a program now, or ask your GP about it!

List #3 – Who can benefit from cardiac rehabilitation?

  • Post MI – After heart attack
  • Acute coronary syndrome – Heart attack is the final stage, but even unstable angina (new onset chest pain with exertion, or chest pain at rest without sign of heart attack on EKG or increase in cardiac enzymes) should be referred to cardiac rehabilitation.
  • Any cardiac operation – Any valve replacement, bypass operation or others.
  • Percutaneous Cardiac Intervention – This is the procedure in which a wire is thread through your leg or arm to your heart. Anybody who has this procedure, even if it’s diagnostic can benefit afterwards from cardiac rehabilitation.
  • Stable angina pectoris – Chest pain with exertion which gets better at rest.
  • Any coronary artery disease
  • Congenital heart failure – If there is shortness of breath with mild to moderate exertion due to heart failure.
  • Arrhythmias
  • Peripheral vascular disease
  • Post ICD – Therapy and rehabilitation is largely psychological, people are very reserved and this is worse for them rather than moving.
  • Heart transplant – Pre-operation and post-operation.

As you can see, this list is much more extensive than just patients after heart attacks. Cardiac rehabilitation is without a doubt one of the most under-diagnosed treatments which has incredibly solid proof about how much it helps. If you or someone you know can be put on the list of indications (List #3), make sure you ask your GP for a referral to cardiac rehabilitation.

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