Reset your heart health

Heart disease can take decades to develop, with years of poor lifestyle habits contributing to the problem. By the time damage shows up, it may seem like there's no way to reverse it. But a number of pro-grams — typically offered in group sessions, in an outpatient hospital or community setting — can help you change unhealthy habits, reduce heart attack risk, and boost your longevity. Here's a look at some of the available programs.

Cardiac rehabilitation

Cardiac rehabilitation ("rehab") is a medically supervised three-month program for people who've had a heart attack, heart bypass surgery, a heart or a heart and lung transplant, stenting to open arteries, or valve surgery, as well as those with chronic chest pain (angina) or certain kinds of heart failure.

A team of doctors and other experts assess participants' health needs and develop individualized treatment programs that focus on exercise, a heart-healthy diet, weight control, stress reduction, sleep, and medication adherence. Groups meet for education and training several times per week, for three months. "We give you the tools to make lasting change. For instance, we work with you to overcome barriers, such as how to cope with arthritis that's keeping you from exercising," explains Dr. Romit Bhattacharya, a preventive cardiologist at Harvard-affiliated Massachusetts General Hospital (MGH).

Experts also guide participants' progress and monitor their exercise sessions. "You have an exercise physiologist there with you, so you learn what it feels like when you're safely pushing the limits and when you should pull back. That helps address the fear element about whether you're overdoing it," Dr. Bhattacharya says.

It adds up to proven benefits. Evidence suggests that people who attend cardiac rehab reduce their risk of heart attack by 31%, and that people who complete all 36 sessions (typically in three months) reduce their risk of death by 47% compared with those who only complete one session. Cardiac rehab also improves overall physical function and reduces chest pain.

Cardiovascular wellness programs

Cardiovascular wellness programs are for people who don't qualify for cardiac rehab but want to improve their heart and blood vessel health. They're offered at hospitals, academic centers, private doctor practices, fitness centers, and even community centers.

Programs vary greatly in their approaches, expertise, topics, and length. Some are similar to cardiac rehab, with a team of health professionals who provide months of health monitoring and training. An example of that is MGH's Cardiac Lifestyle Program. It's for people who have an abnormal heart rhythm, certain kinds of heart failure, obesity, diabetes, or at least one heart disease risk factor (such as elevated weight, blood sugar, cholesterol, or blood pressure).

Other programs are open to anyone and have just one or two experts who focus on a few areas of health. These programs may last for a couple of weeks or even just one session.

Who pays for these programs?

Costs vary by program and provider. For people with qualifying conditions, insurance (including Medicare) covers the costs of cardiac rehab and a similarly classified program called the Ornish Reversal Program, offered at certified hospitals and clinics across the country. Depending on the provider, the Ornish program is also open to anyone who wants to improve cardiovascular health and is willing to pay for it out of pocket (for about $7,000 to $10,000).

Other programs, such as MGH's Cardiac Lifestyle Program, are partially covered by insurance. And some others are free or have a minimal charge.

Make sure the program is clear with you about are what services it offers, how much it costs, how many experts are involved, and how often and where your group will meet.

Program barriers

Despite the benefits of these programs, many people don't use them. "By some estimates, only 10% to 34% of people who qualify participate in cardiac rehab," Dr. Bhattacharya says. "It's often because of the diagnosis. For instance, only 10% of patients with heart failure are referred to the program, and less than 3% attend. Prevention is something that doesn't get as much of a spotlight as it should."

Other barriers to these programs include transportation issues, fear of being too unfit to take part, and unconscious bias in referrals. "Women and minorities, and people with limited English language skills, are less likely to be referred or participate," Dr. Bhattacharya says. He stresses that we need to change this thinking. "These programs are not yet 'democratized' and made available to as many people as they should," Dr. Bhattacharya notes. "But it could be that everyone would benefit from a group-based program to live the healthiest life they can."

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