Cardiac rehab - giving heart patients their lives back

So, thanks to NICE publishing an updated guide on the management of chronic heart failure, we now know even more about the benefits of cardiac rehabilitation.

But so what? Why is cardiac rehabilitation so important to the thousands of heart patients out there?

Well the simple answer is it saves lives.

At the moment only 38 per cent of heart patients enjoy the benefits of cardiac rehabilitation - that figure should, and could, be much higher.

The term rehabilitation can actually be a bit misleading. Basically, it is a tailored program of information, education, exercise, lifestyle advice and help with medication.

Crucially it’s also advice and help with the worry, and sometimes depression, associated with this serious disease. In short, it puts you back in control of your life.

It could cost the earth but is doesn’t. Cardiac rehab can cost as little as £600 per patient. Not a lot when it comes to changing - or even saving - someone’s life.

After all, we already know the number of people who die from heart problems after their cardiac treatment is reduced by a quarter following rehabilitation.

It’s an incredible service and yet it is still available to so few.

The prize is improving people’s lives and using NHS resources better by reducing the burden on expensive hospital admissions.

This is a problem that we can fix. For the sake of heart patients and their families, the NHS needs to drive up the numbers benefitting from cardiac rehabilitation.

You can find out where your nearest cardiac rehabilitation programme is by visiting www.cardiac-rehabilitation.net or calling the BHF Heart HelpLine on 0300 330 3311.

By Dr Mike Knapton

New smoking figures - bitter sweet news

Today’s figures on the number of people smoking – and quitting – are bittersweet.

The latest NHS statistics show that while more people are kicking the habit, the percentage of smokers in England has remained the same. While it is great news that more people are successfully quitting, it sadly looks as though the tobacco industry is still able to recruit legions of new smokers to replace those who quit - or die from smoking related ill health.

We know the tobacco industry is trying harder than ever to find new recruits, which is why those firms are so opposed to new laws banning cigarette vending machines and tobacco displays in shops.

It’s a fact that two thirds of smokers start before they are 18, and we know tens of thousands of teenagers regularly get hold of cigarettes from vending machines because they are an easy source of tobacco where people rarely check for age identification.

We campaigned hard for this new law because banning vending machines would cut off this easy access to cigarettes by young people and getting rid of tobacco displays would close off one of the few remaining ways for tobacco firms to market their products to such an influential audience.

Everyone, even the tobacco firms, know that smoking is bad for you and the scientific case against it is long and well established. It’s a major risk factor for developing heart disease borne out by the depressing figure that 25,000 smokers die every year from smoking related heart disease. A total of 114,000 smokers die more generally as a result of their habit.

Yet tobacco firms are hard at work lobbying the Coalition government in the hope ministers will back down. We think we should be doing everything we can to protect children from smoking. You can help by writing to your MP asking them to make sure this law becomes reality. The health of our young people depends on it.

By Joseph Clift

Policy Officer

Live chat nurse Judy - the final question

Katie asks: “Hi, I am 27 years old and was born with my left coronary artery on the wrong side. I had this re-implanted at 10months old and also suffered a heart attack. I have since found out in October last year that my valves were leaking and they were going to replace them up until I had an angiogram in January and they discovered my heart was enlarged. Plus almost 1 1/3 of my heart is just scar tissue from having the heart attack as a baby. So I was told the only option for me was a heart transplant. So I now take 3 different meds a day and I am becoming more symptomatic showing breathless, limited exercise tolerance and chest pain. I have been referred to another consultant for a transplant assessment and wondered what this entails exactly? I am a mother of 3 and a wife, as you can imagine this is a very anxious time for us all. How long is recovery after transplant? How long will I be in hospital for? Look forward to hearing from you.”

Judy says:

I am so sorry to read of your very complicated medical history and of your need to have a heart transplant so young. I totally appreciate how hard it must be for you, your husband and your young family. The recovery period following a heart transplant varies considerably from one patient to another. You can read more about what to expect before and after the surgery in our BHF publication on heart transplants. I hope that you will be ok, that you will be accepted for the surgery and that you will be given a new heart soon. If you want to chat about this you might find it easier to call our HelpLine on 0300 300 3311 and talk to a cardiac nurse. I wish you good luck with everything and I hope that you have the support you need and deserve from family and friends.

You may also want to contact the heart transplant support network on 0800 027 4490 or the their website.

Live chat with nurse Judy

Frances asks: “My 16 year old son had open heart surgery last month to replace aortic valve. As a result of heart block, he has now had a pacemaker fitted. Once everything is healed, and he is fully recovered, what is the maximum weight he can safely lift? The reason for asking is that he is looking at career choices and wouldn’t want to choose something physical if it could affect his health.”

Judy says:

I hope your son is making a good recovery from his open heart surgery and his pacemaker insertion. It’s hard to give you a definitive answer to your question as I don’t know his full medical background and the type of heart condition he has. If he has congenital heart disease, he should have a chat with his cardiologist about career choices. Some young people with complex congenital heart disease are encouraged not to do weight lifting but others with more simple congenital heart disease do not need to be so careful. I hope that your son’s cardiologist will be supportive and give you him the advice that he needs. I wish him luck with his health and his career choice.

Live chat with nurse Judy

Denise asks: "Hi Judy I’m 42 awaiting valve surgery they have said I’ve got a tiny femoral artery it needs some electrical rewiring and there’s a hole. I’m just a bit worried about being on warfarin all my life they have said if it cant be repaired a metal valve will be fitted any info about the warfarin I’d be grateful thanks."

Judy says:

I am sorry to read that you need to have valve surgery and I understand your concern about taking warfarin for life. There are benefits and risks associated with taking warfain which you can read about here. If you have a metal valve replacement you will have to take warfarin for life as otherwise a potentially fatal clot would build up on the valve. When making the decision about surgery what you need to consider is what are the risks associated with the surgery (and with warfarin) versus the risks associated with not having the surgery in the first place.

It might be worth talking to your surgeon about this again if he or she did not explain the risks of not having surgery. You can read more about valve disease here. Whatever you decide I wish you good luck with it and good health for the future.

Live chat with nurse Judy

Eric asks: I had a minor heart attack in 2002 and have been put on ramipril, simvastatin, metoprolol tartrate and asprin for life. What evidence is there to prove that I will live any longer taking the pills. Being a scientist by training I like to evaluate evidence for myself and not do something because some government dept. thinks its a good idea! I run, go to a gym twice a week and have not had a problems since 2002. Have I improved my chances of avoiding HA or are the chances still the same as if I had put my feet up?

Judy says:

I am sorry to read that you have experienced a heart attack but it’s great that you have made a good recovery. It’s difficult to point you in the direction of the evidence which supports the use of the cocktail of medication used to prevent a second heart attack as this evidence is not in one place. As a scientist yourself I am sure you will appreciate that the vast body of evidence has been accumulated over many years from scientists and medical researchers across the world. If you have a look at the stats on our website you will see that the death rate from heart disease has been steadily declining and the medication prescribed post a heart attack will have contributed to this decline. Other contributing factors include more prompt diagnosis and better access to emergency treatment (clot busting drug) at the time of the heart attack.

But you are right when you point out that medication alone is not enough and a healthy lifestyle is a vital part of the post heart attack rehabilitation. Its great that you have taken control over your health by going to gym twice a week.

I hope that this has answered your questions and I wish you good health in the future.

Live chat with nurse Judy

Janie asks: “How does a Bivent work I understand the pacing and defib, but unsure about the other function, I have one fitted due to Cardiomyopathy”

Judy says:

The benefit of biventricular pacing is that it in addition to regulating the heart rate, it can help to improve the pumping function of the heart muscle. There are three leads, one in the atrium, one in right ventricle and one in the left ventricle. By pacing both ventricles it help to synchronise them and thereby helping to make the heart more efficient. This can help to relieve symptoms. You can read more about biventricular pacing in our booklet pacemakers and more about cardiomyopathy here.