Professor Michael Thompson, professor of cardiac surgery at Michigan Medicine, talks about how a cardiac rehab program is having lasting effects on cardiac patients.
Interview conducted by Ivanhoe Broadcast News in 2023.
Can you tell us more about the cardiac rehab program? How did this come to be?
Thompson: The study is funded by Blue Cross Blue Shield of Michigan value partnerships. They fund statewide collaborative quality initiatives in the state of Michigan. It’s a collaboration between the Michigan Value Collaborative, which I co-direct, and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. We work together to try to identify gaps in care for patients undergoing heart surgery. It was funded by those groups as well as a grant from the Agency for Healthcare Research and Quality. The study really came about because we identified cardiac rehab as something that we know to be beneficial, but we just didn’t know enough about it, particularly for our residents of Michigan.
What did the study find?
Thompson: We found that for patients attending cardiac rehab, it greatly improved survival post-surgery, but despite that, just over half of the patients attended a single session. But beyond that, only 12% of the patients attended all the 36 sessions that are recommended. Unfortunately, despite the really beneficial effects we saw, a very few patients attended a single session of it.
Why?
Thompson: There’s a lot of barriers. I think one thing that our study found is that despite referral rates being really strong, attendance rates were not matching that. We tried to identify the different barriers patients may have, such as not knowing they’ve been referred, lack of knowledge regarding cardiac rehab, transportation, or insurance cost sharing. We frequently find that the minority populations have much lower rates of cardiac rehab attendance, and the factors I mentioned earlier are often magnified in those populations. I think we need to do a better job of trying to reach them so that we can help them overcome those barriers moving forward.
How do you define cardiac rehab?
Thompson: It’s a multifactor therapy, so it’s both exercise training, but it’s also education and teaching. Teaching patients healthy behaviors and reinforcing those healthy behaviors; whether it’s nutrition, diet, medication, adherence, and smoking cessation. Social support is also really important for patients that just underwent heart surgery. The average person will hear of the barriers, and choose to do as they wish despite having undergone a bypass surgery.
Why do you think cardiac rehab gets placed on the backburner by so many?
Thompson: Once patients have completed surgery there’s a lot that they’re trying to take in at once. Whether it’s new medications they have to take, self-care, or even just trying to come to grips with what just happened. So often cardiac rehab gets thrown into the mix of all the things that a patient is told they have to do now after surgery. I think the fortunate thing they were trying to convey is that cardiac rehab can reinforce all of those things together. It’s a really good first step for patients because it can take all the things that they’re being told to do and wrap it into one package.
The study was conducted between 2015 and 2019, is that right?
Thompson: Yes.
How many patients were there?
Thompson: I think it was about 8,000 patients in our study.
Did all the participants have a bypass surgery?
Thompson: All patients underwent isolated bypass surgery. But they weren’t doing valve procedure, or anything of that kind, at the same time.
How many weeks would 36 sessions equate to?
Thompson: Usually the recommendation is to attend 36 sessions over a 36-week period. Sometimes patients will do two or three sessions a week. It can vary from patient to patient depending on their work schedules, schedules at home, or how frequently they’re able to get in.
How did the individuals who attended all 36 sessions benefit from the treatment?
Thompson: What we found is that the more sessions you attended, the greater the benefit, at least in terms of long-term survival. There are other well-documented benefits for cardiac rehab that we didn’t look into. Things like quality of life, functional status, or emotional status. Those are not things that we looked into for our study, but those have been well-documented and it continues to reinforce the benefits for longer-term sustainability.
What’s technically considered long-term survival with a study like this?
Thompson: It varies from procedure to procedure. I think we see often 2, 3, 4, 5 year survival of patients. Roughly 90-95% can live to that. What we discovered is that survival was improved by about 5-6 percentage points for attending a single session, and much greater for those that attended all 36.
Is it safe to assume that if somebody attended about half of the 36 mandated sessions, their survival rate would go up? Of course not as much as completing all 36.
Thompson: Correct. Yes, so we looked at a very dose-response. At increasing levels we found increasing benefits. It’s a very stepwise incremental benefit for every additional number of sessions you attended.
What would you say is the biggest takeaway from all of this?
Thompson: I think the biggest message is that we need to do better and try to get more patients to attend cardiac rehab. We need to try to identify what patient’s individual barriers are. We need to try to educate both patients and providers. One thing that we’re trying to do is work with our providers across the state to reinforce the benefits, that it’s not just exercise. Patients are receiving a lot more than that, and so we really are trying to do better at informing both our patients and their providers about what cardiac rehab is and the benefits it boasts. Patients will often listen very closely to what their surgeon tells them after surgery, so if a surgeon gives a very strong endorsement we know patients are much more likely to go because of that.
END OF INTERVIEW
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