Why cardiac rehab is key to recovery from a heart event

Published January 2024 | 5 min read
Expert contributors Associate Professor Nikki Bart, heart failure and heart transplant cardiologist at St Vincent’s Hospital Sydney and Clinical Faculty Member with the Victor Chang Cardiac Research Institute
Words by Karen Burge

Innovative cardiac rehabilitation programs are helping to bring healthy heart (and mind) benefits to more people who need it.

When Melissa Del Popolo felt constant pain in her shoulder, she brushed it off as an injury from past breast cancer surgery. She even downplayed almost passing out at the gym. But after a visit to her GP, Melissa discovered she had high blood pressure and was referred for a stress test. It was during this test that her heart literally stopped.

The Perth-based 55-year-old had what’s known as a sudden cardiac arrest, where the heart stops beating due to an electrical problem. Doctors also discovered a blocked artery, which required a stent.

An Australian Institute of Health and Welfare report shows that in 2020 there were around 56,700 ‘acute coronary events’ in people over 25 (155 each day), and about 12% were fatal.

Melissa knows she’s lucky to be alive. Having a healthcare team within reach of a life-saving defibrillator meant she received prompt emergency care. But it’s what comes after surviving a heart event that can make a significant difference to your long-term health and future risk.

What happens after a heart attack?

A heart event can be life changing and the steps ahead overwhelming. But you don’t have to go through it alone. A cardiac rehabilitation program is the gold standard in recovery care, bringing together a team of experts to provide personalised support, education and guidance. A program usually starts in hospital and continues in the home or community over six to 10 weeks.

Associate Professor Nikki Bart, a heart failure and heart transplant cardiologist at St Vincent’s Hospital Sydney, says patients are taught about important lifestyle changes, such as nutrition, safe exercise, smoking cessation and emotional wellbeing, as well as learning to manage their condition, risk factors and medications.

The program is open to a wide range of heart patients, including those who’ve had heart attacks, heart failure, cardiac arrest, a transplant, pulmonary hypertension or a device fitted, explains Dr Bart, who’s also a Clinical Faculty Member with the Victor Chang Cardiac Research Institute.

"Having a cardiac event means that we've got to do everything in our power to avoid a future event," she says. "Being on a program helps keep patients well for their lifetime."

Research shows long-term benefits for patients who participate in cardiac rehab, including lower mortality rates and fewer hospital readmissions.

Cardiac rehabilitation: extending the reach

Despite its benefits, the uptake of cardiac rehab in Australia could be as low as 30%, according to the Heart Foundation. Some of the barriers include transport difficulties, returning to work and living in rural or remote areas.

The Royal Flying Doctor Service (RFDS) has been responding to the essential healthcare needs of country Australians for almost a century. One in five RFDS emergency flights are for heart attack and stroke. And an average of 112 patients per week are retrieved by the RFDS from country areas for heart treatment. So ensuring our rural and remote communities have access to cardiac rehab is essential for good health outcomes.

To help deliver on our social mission to build healthier communities, we’ve established a three-year major national partnership with the RFDS. Together, we’re committed to improving healthcare access and outcomes for rural and remote communities through the delivery of essential healthcare and services to every corner of Australia.

This need for better access to cardiac services has given rise to home-based rehab, with the potential to reach more patients. Dr Bart describes online programs as "game changing" for patients who have struggled to access face-to-face services.

"We’re also able to recommend other technology that complements an online program, such as blood pressure cuffs to monitor blood pressure during exercise sessions and wearable activity trackers [like smart watches], so that patients can be provided with some of the resources they’d have when attending in-person sessions," she says.

How to support your cardiac rehab

Back on Track is an important initiative bringing cardiac recovery support into the home. This free, self-management program delivered online is designed to help people improve their behavioural and emotional wellbeing after a cardiac event.

Anyone who has experienced a heart event, like a heart attack, heart surgery, stent or unstable angina, can register – all you need is access to a computer or tablet and an internet connection.

The program is self-paced and includes learning modules on goal-setting, physical activity, healthy eating, smoking cessation and emotional wellbeing. It’s also interactive, with quizzes, links to online resources, a printable workbook and space for participants to record notes and reflections along the way.

The HCF Research Foundation, the leading non-government funder of health services research, supported the initial development and pilot study for Back on Track and funded a recent study into how best to deliver the program (self-directed versus phone support). Head of the Foundation, Dr Chris Pettigrew, says results show Back on Track is an effective and accessible option and complements a suite of existing services for patients who’ve experienced a heart event.

The research also found participants experienced reduced depression rates, eased anxiety and increased physical activity after completing the program.

Managing mental health

For Melissa, managing unexpected anxiety was one of her biggest challenges. “My heart issues completely changed the way I look at life. Having my heart just stop threw me, mentally,” she recalls.

"I suffered from bad anxiety afterwards, which I'd never had before. Not many people get to experience the fragility of life. Here one minute, gone the next. It took me a very long time to come to terms with it, and it still affects me if I’m honest."

Unexpected changes in mood and emotions – including sadness, sleeplessness, anxiety, social withdrawal and loss of interest in life – can be common after a heart episode. Known as cardiac blues, it affects around 75% of people who’ve had a heart event, says the Australian Centre for Heart Health. While it usually eases with time, patients should speak to a health professional if symptoms don’t improve.

Heart Foundation Healthcare Programs Manager Natalie Raffoul says one in five patients meets the diagnostic criteria for major depression after a cardiac event, and two in three experience severe anxiety.

"Anxiety and depression have a negative impact on cardiac patients’ health outcomes, including premature mortality, recurrent events and re-hospitalisations, higher healthcare use, reduced quality of life and poorer adherence to health-enhancing behaviours," she explains.

Being part of a cardiac rehab program, in-person or remote, is one way to help catch any early warning signs, adds Dr Bart.

Staying positive

While recovering from a heart event can feel overwhelming, Dr Bart says it's also an opportunity to make improvements for a heart-healthy future.

For Melissa it means following healthy heart recommendations, staying physically active and taking a regimen of medications (beta blockers, aspirin and statins). She also practises mindfulness and enjoys the "life-changing" benefits of yoga to help keep her mental health in check.

"I take looking after my heart very seriously," she says. "I recently had a stress test and passed with flying colours… Apparently, I'm not only doing well for a woman who had a cardiac arrest, I'm doing well for any woman in her mid-50s."

Personalised help for heart conditions and diabetes

You can trust HCF to help you be your healthiest self, that's why we’ve launched The COACH Program®^*. Delivered by qualified health professionals, this telephone support program is provided by health coaches, at no extra cost for eligible members^* with heart conditions or diabetes. You'll be teamed with one of our qualified in-house coaches including dietitians, pharmacists or nurses, for up to six coaching sessions to help you improve your heart health.