News Release

UNC-CH study finds N.C. outpatient heart rehabilitation programs mostly under-used

Peer-Reviewed Publication

University of North Carolina at Chapel Hill

CHAPEL HILL -- Too few people with heart problems -- especially women and minorities -- use outpatient cardiac rehabilitation programs across the state, according to a new University of North Carolina at Chapel Hill study. Medicare would pay for participation in many cases, but patients often do not know it.

"In 1995, heart disease was responsible for 31 percent of deaths in North Carolina, and we had the eighth highest death rate in the country from that cause," said Dr. Kelly R. Evenson, postdoctoral fellow in epidemiology at the UNC-CH School of Public Health. "Our survey of outpatient cardiac rehabilitation programs operating in North Carolina in 1998 found that fewer than 5,000 patients were using the services that returned the questionnaires."

In fiscal 1995-96, 114,361 people were hospitalized in North Carolina for ischemic heart disease, another 45,082 for congestive heart failure and another 77,721 for other cardiovascular problems, Evenson said. Many patients who survive might benefit from outpatient cardiac rehabilitation, which helps them adopt healthier lifestyles.

"From 1991 to 1995, nearly half of all coronary heart disease deaths in North Carolina occurred in women, but we found that cardiac rehabilitation use by women was lower than that by men," she said. "Even more problematic is the low rate of participation by minorities even though coronary death rates are higher for African-Americans than for whites."

A report on the research appears in the March-April issue of the North Carolina Medical Journal, which has just been published. Along with Evenson, Dr. Wayne D. Rosamond, associate professor of epidemiology, wrote the report.

Their study involved sending detailed five-page questionnaires to directors of the 72 outpatient cardiac rehabilitation programs in North Carolina in 1998. Directors of 61 eventually returned the surveys for an 85 percent response rate, Evenson said. They were asked to describe services offered, locations, staffing, training, patient populations and other program characteristics.

Such rehabilitation efforts include medical evaluation, reduction of risk factors such as stress and smoking, nutritional counseling, aerobic exercise, weight training and education about work, drugs, weight loss and other healthy practices, she said.

Researchers did not investigate inpatient cardiac rehabilitation efforts since those are short-term, lasting only as long as patients are hospitalized. People who could benefit from longer-term rehabilitation include those who have suffered heart attacks, have undergone bypass surgery or experienced angina, chest pains resulting from an inadequate oxygen supply to the heart.

Other findings were that: . 50 of the state's 100 counties had cardiac rehabilitation programs, mostly organized around hospitals. . lack of money was among the most common reasons patients said they did not participate. . the coastal plain had the fewest programs. . patients traveled an average maximum of 30 miles to reach them. . only four programs routinely operated at full capacity.

"We need to consider alternative efforts to help people who live too far away from cardiac rehabilitation centers," Evenson said. "We also need to understand better why people who do live close by often do not take advantage of these services."

Among the possibilities are increased use of nurse case managers who offer counseling and often can monitor heart rhythms over the telephone, she said. Patients need to check with their health maintenance organizations or insurance carriers and doctors to find out whether outpatient cardiac rehabilitation is covered by insurance.

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Note: Evenson can be reached at 919-966-1967, Rosamond at 966-966-7419. Respectively, their e-mail addresses are kelly_evenson@unc.edu and wayne_rosamond@unc.edu. Contact: David Williamson, 919-962-8596.


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