Many people feel scared, confused and overwhelmed after a heart attack, which can be a life-changing event. Prevention of another heart attack and cardiac rehabilitation should be a priority to speed recovery and to improve quality of life.

Did you know?

According to the World Health Organization (WHO), 80% of cardiovascular diseases like heart attacks and strokes are preventable.¹

Four out of five people who die from cardiovascular disease (CVD) are killed by a heart attack or a stroke, and one third of these deaths occur in people under 70 years of age.^{2, 3}

In Australia, coronary heart disease is the leading cause of death for males and the second most common cause for females, after dementia and Alzheimer’s disease.⁴

Every 90 minutes, someone in New Zealand dies prematurely from heart disease. Many of these deaths are preventable.⁵  

After a heart attack, only about 30% of Australian patients are referred to cardiac rehab, and only 28% of those referred actually attend.⁶  

The Facts

Cardiac rehabilitation programs

• Cardiac rehab programs were developed to provide a personalised approach to preventing a second heart attack or other heart diseases, and are the most cost-effective means of improving a patient’s outcomes.⁷
• They can be delivered by phone, online or face-to-face, either in hospital or in the community.
• Following an initial medical evaluation of physical, mental and emotional health, a cardiac rehab program is developed. This incorporates goal-setting, supervised exercise, education about self-management and optimising risk factors, and psychological support, in addition to support from other patients.
• This integrated approach addresses not only the physical effects, but also the psychological effects of having a heart attack. As a result, death and disability, hospital admissions and cardiac risk factors are lowered, while quality of life can be improved to the point where the patient is able to return to work and normal life.⁷

Who should participate?

• Cardiac rehab following a cardiac event occurs a few days after hospital discharge.⁷ Evidence from the US indicates that the following conditions respond to cardiac rehab^{8, 9}:
  • Stable angina (chest pain)
  • Recent myocardial infarction (heart attack)
  • Heart failure
  • Recent coronary artery bypass surgery (CABG)

What are the benefits?

• Cardiac rehab has been shown to reduce the frequency of hospital readmissions by 40% and death from a second heart attack by 25%.¹⁰
• Cardiac rehab saves lives and reduces healthcare costs because it^11-16:
  • Reduces mortality
  • Accelerates recovery
  • Improves clinical outcomes (e.g. cholesterol, blood pressure)
  • Improves behavioural outcomes (e.g. exercise tolerance, quit smoking)
  • Reduces repeat cardiovascular events and hospital readmissions
  • Strengthens adherence to medication, and
  • Enhances mental health and quality of life
• One in two people are unable to return to their original work capacity, and one in four don’t return to work at all.¹⁷ Cardiac rehab supports people as they strive to return to a productive life and stay out of hospital.

How does it work?

Cardiac rehab programs are delivered by a dedicated team, including doctors, nurses, exercise specialists, therapists, nutritionists and counsellors. Programs typically include the following core components:¹⁸

• Foundations of cardiac rehab:
  • Initial assessment and goal setting: Information is collected and assessments are made in the following areas:
    • Exercise capacity to evaluate the risk of cardiovascular complications from a training program.
    • Lifestyle risk factors (physical activity, diet, smoking, alcohol)
    • Psychosocial health (depression, anxiety)
    • Medications
    • Adiposity (waist circumference)
    • Medical risk factors (blood pressure, lipids, blood glucose)
    • Quality of life
    • Return to activities of daily living
  • Heart education and self-management: In order to develop problem-solving skills to manage their condition, patients are educated in cardiovascular anatomy and disease.
• Developing knowledge of heart health:
  • Exercise training
    • Usually tailored to individual needs, exercise is supervised and may include aerobic and resistance training with progressive intensity.
    • Formal sessions include at least 30 minutes of aerobic activity – longer if combined with resistance training, balance training or stretching. This occurs 1-3 times per week, but activity on most days is recommended.
  • Healthy eating and weight management
    • A dietician provides education and assistance to adopt a healthy diet and reduce weight. This includes:
      • Serving sizes, number of serves and meal planning
      • Whole plant foods, lean meat and low-fat dairy options
      • Healthy whole-fat foods and oils
      • Herbs and spices to replace salt
      • Water as the fluid of choice.
    • Patients are referred to expert weight loss programs where needed.
  • Quit smoking and alcohol reduction
  • Education and review of medications
    • Discuss commonly prescribed medications, their benefits, side effects and use.
    • Emphasise the importance of taking medications and consulting a GP before changing or stopping medications.
  • Management of medical risk factors
    • Patients are educated and provided with support to reduce the most common risks of high blood pressure, high cholesterol and type 2 diabetes.
• Psychosocial health
  • Depression, anxiety and denial are common in patients following a heart attack.^{20, 21} In fact, one in five heart attack patients also suffer major depression, increasing their risk of death and further cardiac events.¹⁹
  • Cardiac rehab programs address psychosocial wellbeing by:
    • Discussing typical emotional responses to a cardiac event.
    • Identifying and broadening social support available to patients.
    • Helping patients to recognise signs and symptoms of depression and other mood disorders, and know where to seek help.
• Life beyond cardiac rehab
  • Participants are helped to return to activities of daily living, such as:
    • Driving
    • Sexual intimacy
    • Work – by addressing barriers and developing strategies for a graded approach.
    • CPR training
  • Reassessment and completion of rehab includes:
    • Reviewing participant’s goals
    • Providing a discharge summary for GP and cardiologist

When should I join Cardiac rehab?

• The first visit to an outpatient cardiac rehab program can occur a few days after hospitalisation, in the case of an uncomplicated heart attack or revascularisation surgery.
• More complicated cases involving coronary artery bypass grafting (CABG) or complex hospital courses will typically start later.²⁰
• Early enrolment improves subsequent attendance and outcomes.^21-23 Delaying cardiac rehab by more than 30 days has been linked to decreased improvement in exercise performance.²⁴

Home-based programs

• Home-based cardiac rehab is increasingly recommended.25-27 It is similarly effective in improving clinical outcomes and health-related quality-of-life in patients with heart failure, or after heart attacks or revascularisation.28 Local availability and patient preference may guide this choice.

What can we do about it

If you or a loved one have just experienced a heart attack, the following recommendations should be followed to reduce the risk of having a second cardiac event.

• Attend cardiac rehab. If none was provided at hospital discharge, it is important to follow-up with the discharge team.
• Know your medications and take them as directed.
• Attend all follow-up appointments. It is important to attend these appointments so your doctor can monitor your condition and recovery.
• Seek support. Loved ones and others who have experienced a heart attack can help you overcome the fear and anxiety that patients commonly feel.
• Change your lifestyle. Following a lifestyle that promotes physical and mental health is vital to manage risk factors and reduce your risk of further cardiac events:
  • Follow a healthy plant-based diet
  • Drink water rather than sugary drinks or fruit juices
  • Lose any excess weight
  • Maintain recommended levels of physical activity
  • Manage your stress
  • Stop smoking
• Find support to safely return to work after injury. Different states and countries have different programs to help people to return to work if a heart attack has largely been related to stress or demands at work. Links have been provided below to find information on how to access work support in Australia and New Zealand:
  • NSW
  • VIC
  • SA
  • QLD
  • TAS
  • WA
  • NT
  • ACT
  • New Zealand