While ample research has shown coronary rehabilitation programs help coronary heart disease (CHD) patients improve, many European patients are not benefitting from these services, according to results of the EUROASPIRE III survey published June 19 in the European Journal of Preventive Cardiology. More focus should be placed on these cost-effective programs, as they help ingrain lifestyle behaviors and improve risk management.

The cross-sectional EUROASPIRE III study was conducted at 76 centers across 22 European countries and included patients who had a previous coronary event or revascularization performed prior to age 80. The researchers evaluated 13,935 medical records and interviewed 8,845 patients.

“Since 1969, the focus of cardiac rehabilitation has evolved from supervised exercise sessions and return to work in patients recovering from acute myocardial infarction or cardiac surgery into more comprehensive programs including health education regarding smoking, diet and physical activity, risk-factor management in terms of controlling elevated blood pressure, dyslipidaemia and diabetes, and the use of prophylactic drug therapies,” Kornelia Kotseva, MD, of the National Heart and Lung Institute at Imperial College London, and colleagues wrote.

The American Heart Association, American College of Cardiology and the European Society of Cardiology have all recommended cardiac rehab programs as a cost-effective treatment strategy for patients with CHD.

There was wide variation within the study populations between countries, from 121 patients in Greece to 536 patients in Bulgaria. Of the total cohort, 19.5 percent underwent CABG; 41.5 percent underwent PCI; 19.4 percent had acute MI; and 19.6 percent had ischemia.

The researchers reported that 44.8 percent of the study population were told they should go to rehab by physicians and only 36.5 percent (81.4 percent of those advised to do so) attended some form of cardiac rehab.

Less than 10 percent of patients seen in Greece, Cyprus, the Russian Federation, Spain and Turkey were advised to attend cardiac rehab. Among the other countries, the participation rate of those advised to rehab varied from 31.7 percent in Bulgaria to 95.6 percent in Lithuania.

While the authors found no differences in age or gender, they did find that younger patients, those who underwent CABG and those with a history of MI were more often advised to go to rehab. Patients who underwent PCI, had a history of angina and those with lower cholesterol levels were less likely to be recommended to attend rehab.

In terms of data from specific countries, the authors found that:

• In France 32.4 percent of CHD patients were advised to attend rehabilitation, and of those advised, 90 percent attended.
• In Germany 56.6 percent were advised, and 91.1 percent attended.
• In Italy 51.5 percent were advised, and 88.7 percent attended.
• In the UK 43 percent were advised, and 80.6 attended.
• In Spain 3 percent were advised and less than 1 percent attended.

"There is an urgent need to raise the standard of secondary prevention," Kotseva said in a press release.

"To achieve the clinical benefits of a prevention program, we need to integrate professional lifestyle interventions with effective risk factor management and evidence-based drug therapies appropriately adapted to the medical, cultural and economic setting of a country. The challenge is to engage and motivate cardiologists, physicians and health professionals to routinely practice high quality preventive cardiology in a healthcare system which invests in prevention,” Kotseva summed.