Jan 23 2010
How do you change health habits among a population with some of the highest heart disease rates in the world? Tackling heart disease in Kentucky - an epicenter of heart health problems - the University of Kentucky Gill Heart Institute Cardiac Rehabilitation Program is helping high-risk patients make radical, lasting changes to improve their heart health.
"People have a notion of heart disease as something they're born with, but for most people that isn't true. Genetics play a role, but lifestyle accounts for the majority of heart disease risk," says Dr. Alison Bailey, Gill Heart Institute cardiologist and director of the cardiac rehab program.
Since the Gill Heart Institute Cardiac Rehabilitation Program opened in February 2009, dozens of patients have undergone total lifestyle makeovers with the help of heart health professionals. Many patients enter rehabilitation after a dramatic event, such as a heart attack. Others self-refer to the program, knowing they are at risk and hoping to avoid a cardiac emergency. Because of its association with the Gill Heart Institute and UK Chandler Hospital, the Gill rehab program sees a variety of patients - from young transplant recipients to middle-aged people with more typical heart disease risk factors.
All cardiac rehabilitation patients benefit from the comprehensive approach of a dedicated team of cardiologists, dietitians, exercise physiologists and health educators, who are determined to reduce the premature mortality risk of every participant. Exercise plans are individualized to fit the needs of each patient - taking into account their medical needs and existing levels of fitness. Dietitians work with patients to create personalized nutrition plans. Every participant benefits from educational programs targeting risk factors such as hypertension, obesity, physical inactivity and diabetes, along with smoking cessation programs. The rehabilitation facility has exercise equipment and qualified trainers on-site, so it's one-stop shopping for patients.
According to Bailey, Medicare and private insurance generally cover 36 sessions of cardiac rehabilitation for a patient who has had a myocardial infarction, bypass surgery, valve replacement surgery, heart transplant, stent placement or angioplasty, or who suffers from stable angina. For patients who complete the initial sessions, the Gill Heart Institute Rehabilitation Program offers a monthly maintenance program at the rate of $55 a month - about the price of a gym membership. However, unlike a regular gym, the Gill program offers participants the chance to improve their health under the supervision of leading cardiologists and experts trained to work with high-risk patients.
The results of cardiac rehabilitation are real. Studies of Medicare patients have shown that participation in a heart health rehabilitation program reduces patient mortality by about 10 percent over a five-year period compared to patients who do not enter such programs.
Although based in Lexington, the UK Gill Heart Institute maintains satellite clinics throughout the state to reach the rural populations at highest risk of heart disease. Bailey herself is a native of Manchester, in the Appalachian region of Eastern Kentucky, so she understands the challenges faced by her patients.
"We have high rates of smoking, and when adults smoke their children are exposed to the dangerous effects of second-hand smoke and more likely to smoke as adults themselves," Bailey said. "Kentucky also has high rates of diabetes, obesity and hypertension and some of the lowest rates of physical activity in the nation. Historically, access to medical care has been difficult in many parts of the state, so when people come in for treatment they often present with more advanced heart disease. We also struggle with high levels of poverty and low levels of education - factors that track with heart disease. Depression and anxiety, other contributors to heart disease, are also high here."
But Bailey is quick to add that, though problems afflicting Kentucky may seem grim, the prognosis for individual patients can be very good. Cardiac rehabilitation has a proven track record of positive results and offers a chance for patients to recover from heart disease by following an individualized program of fitness, dietary modification and education - in short, radically changing their lifestyle. The advice may seem to be common sense - eat well, exercise and practice good health habits - but Bailey has seen that patients need support to make heart-healthy changes.
"A healthy lifestyle isn't complicated," says the doctor, "but it can be difficult. Cardiac rehabilitation offers help."
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