Cardiac rehab uptake lagging in China

Fewer than one-third of Chinese patients with acute coronary syndromes (ACS) receive guidance to participate in cardiac rehabilitation, according to research presented Oct. 11 at the Great Wall International Congress of Cardiology.

Another sobering statistic: only 9.7 percent were given individualized advice.

“All heart attack patients need cardiac rehabilitation and talking to them before discharge is an effective way to encourage participation, but this is an emerging field in China,” study author Guoliang Hu, of the Beijing Institute of Heart, Lung and Blood Vessel Diseases, said in a press release. “The first step towards improving provision is to increase clinician awareness about the benefits of discussing cardiac rehabilitation before patients go home, just as they prescribe discharge medications. China also needs a cardiac rehabilitation referral system, evidence-based programs, and dedicated centers and teams.”

Hu and colleagues used a nationwide registry to identify 62,227 patients with ACS—including unstable angina and myocardial infarction—who were treated at 150 hospitals between November 2014 and June 2017. They found only 32.8 percent of those patients received cardiac rehabilitation guidance before discharge, defined as giving a patient a health brochure or a personalized rehabilitation plan.

Cardiac rehab features advice on managing cardiovascular risk factors including body weight, smoking, blood pressure and stress, as well as diet and exercise modifications. It has been demonstrated to reduce the risks of subsequent heart attack, rehospitalization for heart failure and premature death.

The researchers found men were more likely to receive some cardiac rehabilitation guidance compared to women, at rates of 33.6 percent and 30.6 percent, respectively. Also, patients under 45 years old (34 percent) were more apt to get this advice versus those 75 and older (31.9 percent).

“Prior research has suggested that women and older patients may benefit most from rehabilitation. In our study, these groups were even less likely to receive advice and therefore targeted efforts are needed,” Hu said.

Said study coauthor Dong Zhao, MD, PhD: “The low proportion of acute coronary syndrome patients who receive cardiac rehabilitation guidance, based on findings of this project, may reflect the fact that it is still not integrated into routine hospital-based care for these patients in China. Adding cardiac rehabilitation guidance as an indicator of quality of care and providing more effective training for cardiologists may improve the situation.”