RENEE MONTAGNE, HOST:
We're going to take a look at the best way to heal after a heart attack, through cardiac rehabilitation. Joining an exercise-based cardiac rehab program can substantially cut a patient's risk of dying or ending up back in the hospital. Still, just a fraction of eligible patients sign up. Julie Appleby reports on why cardiac rehab is such a hard sell.
JULIE APPLEBY: Mario Oikonomides is cycling fast on a stationary bike. It looks like he's in an ordinary gym, except for the fact that he's also wearing a sophisticated cardiac monitor.
MARIO OIKONOMIDES: I was 38, and I had the massive heart attack. But a month later, I went to cardiac rehab.
APPLEBY: In rehab, he learned about nutrition, his medications and the role physical activity can play in reducing cardiac risk.
OIKONOMIDES: I've never exercised before, and I became addicted to exercising.
APPLEBY: He's 69 now, and he's had 30 years of good health. But this past winter, he needed bypass surgery. He's back in rehab, and he's doing well.
OIKONOMIDES: So I bought myself 30 years of healthy life as a result of cardiac rehab.
APPLEBY: He's unusual. Fewer than one third of cardiac patients participate in these types of programs. Dr. Ellen Keeley is a cardiologist at the University of Virginia Health System.
ELLEN KEELEY: There's just not enough cardiac rehab programs available 'cause a lot of patients live about a hour away from any single cardiac rehab program. And so that's just an awful lot of driving and time commitment and gas money and all that for patients.
APPLEBY: There's another problem - exercise. It's really hard, especially if you're not used to it. That reality is now colliding with a hospital's bottom line. The Affordable Care Act financially penalizes hospitals if too many cardiac patients come back within 30 days. So some are beefing up the rehab programs and hiring more people like exercise physiologists Courtney Connors. She says patients have a lot of reasons why they don't want to enroll.
COURTNEY CONNORS: There's a little hesitance where they're like I don't really want to come. I don't know if I want to go three days a week. And then their wife or somebody - one of their family members will kind of push them, and then they'll agree to sign up.
APPLEBY: About a year ago, the University of Virginia Health System launched a special clinic. Patients come in about a week after their heart attacks to meet one-on-one with a parade of specialists - doctors, nutritionists, pharmacists and exercise experts like Michelle Adams.
MICHELLE ADAMS: You're Kathryn?
KATHRYN SHIFLET: Yes.
ADAMS: I'm - my name's Michelle. I'm an exercise physiologist.
APPLEBY: Patient Kathryn Shiflet is just 33, and she had a heart attack. She has two young kids, and she's eager to get well. But she's not used to exercise, and she's a bit nervous.
ADAMS: We guide you through it. And there's always someone on a monitor watching your heart rhythm while you do the exercise.
APPLEBY: While patients can exercise on their own, many find it best to be monitored by medical staff as they get used to exercising. But the real problem for Shiflet is that she lives an hour away from the rehab center. Adams lays out her options.
ADAMS: We have an 8 o'clock group that meets Monday, Wednesday Friday; a 10 o'clock group; a 1 o'clock group and a 3 o'clock group.
SHIFLET: I'm just thinking 'cause I'm actually looking at starting a job, and it goes from 4:30 in the morning till 3.
ADAMS: Oh, wow.
SHIFLET: I don't know if I'd be able to get here by then (laughter).
APPLEBY: That's a common problem. Classes can be far away or not convenient for people who are working. Another hurdle is cost. While insurance covers many of these rehab programs, copays can be $20, $40, even $50 a session. Here's cardiologist Keeley.
KEELEY: Yes, cost is an issue because it's not just the copay, but then it's the time off work.
APPLEBY: But perhaps the biggest problem is simply knowing about rehab. Studies show that many patients, especially women and minorities, are never even referred to a program. I'm Julie Applebee in Charlottesville, Va.
MONTAGNE: And Julie Applebee is with Kaiser Health News.
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