Cardiac rehab should be opened up to stroke patients


By Mardi Chapman

9 May 2019

Cardiac rehabilitation, with its focus on exercise and education for modifiable risk reduction, may be suitable as secondary prevention for patients with stroke or TIA.

However few patients with stroke or TIA as a primary diagnosis are currently accessing cardiac rehab programs.

A survey of 149 cardiac rehabilitation coordinators, representing 154 programs in regional and metropolitan Australia, found most (90%) reported that stroke patients made up less than 2% of their patient populations.

Instead, patients in cardiac rehab programs were largely post-CABG, post-PCI or post-myocardial infarction patients.

Most cardiac rehab programs (88.5%) did not include stroke or TIA in their inclusion criteria but neither were those diagnoses listed as exclusions (90.1%).

About half (52%) of the coordinators thought their programs were an appropriate model of secondary prevention for patients with a stroke, especially mild stroke, or TIA diagnosis.

There was little support (5%) for the idea that cardiac rehabilitation would suit patients with severe stroke.

Safety concerns, limited patient to staff ratios, integration difficulties and lack of referrals were some of the top perceived barriers to having stroke/TIA patients in cardiac rehab programs.

The findings are consistent with an earlier Canadian study which found about 5% of patients in cardiac rehab programs had a primary diagnosis of stroke.

“It appears that CR is not provided to people with stroke or TIA in Australia and internationally,” the study said.

Co-author Tom Howes, a physiotherapy masters student from the University of Canberra, told the limbic that stroke rehabilitation tends to focus on recovery of function and restoring independence.

“But you could also argue that there is a deficit as well because best practice rehab guidelines say you should also do aerobic exercise. My suspicion would be because the focus is so much on function, they don’t have time to do it.”

He said there was probably no ‘magic bullet’ to get more stroke patients engaging in exercise for secondary prevention.

“We could try to get cardiac rehab programs to be more accessible for people with stroke which would have huge benefits for them. But there is also definitely improvements to be made from the stroke rehab side.”

The study is part of a program of research, which will also investigate the perspective of neurologists and the stroke team in referring patients to rehabilitation.

“Even though the evidence is small, what there is shows cardiac rehabilitation does work for people with a mild stroke or TIA.”


Already a member?

Login to keep reading.

Email me a login link