About 300 programmes are provided for heart-attack survivors, at a cost of pounds 34m a year, but many who could benefit are not getting help. Two million people are treated for heart disease a year, a third of them women, but one survey showed they accounted for only 15 per cent of those enrolled in the programmes.
The study of research on cardiac rehabilitation carried out by the NHS Centre for Reviews and Dissemination says discrimination in favour of men cannot be justified on clinical grounds. "There is no reason to believe that women, the elderly, ethnic minorities and patients with other types of heart disease would not also benefit."
The government-funded centre, based at the University of York, provides Which?-style advice to doctors and managers on what works and what does not in medical care.
Recovery programmes provide exercise classes, counselling and information to patients, many of whom suffer anxiety and misconceptions about how far they should limit activities to prevent a recurrence. Patients say their main need is practical, honest advice about their condition and how to modify their life to avert more problems.
One question many patients have but are too embarrassed to ask is when it is safe to resume sex. Advice on sex is frequently overlooked and, when provided, is often inaccurate.
Fear about another attack is the most debilitating factor for most patients. Up to half say they are still avoiding physical activity and going out less four years after the event. The review says women who enter recovery programmes do as well as or better than men. Their need appears to be greater, since they are less likely to return to work after a heart attack, are more likely to give up sex and other activities and suffer more from depression.
Patients over 60 have to be cautious about doing too much exercise but research shows they respond as well to it as younger patients. The elderly who join rehabilitation programmes are less likely to be readmitted to hospital.
Among ethnic minorities, heart attacks exact a greater burden, since they suffer more illness and more restriction on their activities, yet they "appear to have been neglected" in research on rehabilitation.
The review says rehabilitation programmes are growing fast and work best when the exercise is combined with psychological and educational interventions. "Given the need to maintain lifestyle changes, the importance of long-term maintenance cannot be underestimated."
A recent study of heart- disease patients found most were not receiving appropriate drugs, were not taking regular exercise, were overweight and were not following an appropriate diet. Up to 90 per cent would have benefited from further changes in lifestyle and only 7 per cent were getting the best medical care.Reuse content