Whether you recently went through something as serious as a heart attack or you just discovered that you have angina, it’s unsettling to know your heart is struggling to function in one way or another. But the good news is that, no matter what’s going on with your ticker, you have the power to change course with your cardiovascular health and cardiac recovery.
What Is Cardiac Recovery?
According to the American Heart Association (AHA), cardiac recovery, also commonly referred to as cardiac rehabilitation, is a medically supervised program (usually with a combination of inpatient and outpatient visits covered by insurance, depending on what you’re recovering from) meant to help you improve your cardiovascular health after a heart-related incident—such as a heart attack, heart failure, heart surgery, or even a diagnosis of chronic angina (chest pain due to poor blood flow to the heart)—and prevent future heart health issues.
“The benefits are great for both those who’ve been hospitalized for a recent cardiac event, as well as those who have a chronic heart condition such as heart failure managed with medications,” says Vinoy Prasad, MD, FACC, FSCAI, a cardiologist and medical director of the Cardiopulmonary Rehabilitation program at Loma Linda University Health. “Research has shown that people who undergo cardiac rehab after a cardiac event are 25% less likely to be readmitted to the hospital for another cardiac event and are more likely to live longer compared to those who don’t undergo cardiac rehab.”
In most cases, cardiac recovery follows a holistic approach; programs usually consist of a combination of supervised exercise training (meaning doctors will likely monitor your blood pressure and heart rate before, during, and after exercise), education on heart-healthy living (including meal planning, nutrition education, and, if you’re trying to quit smoking, a plan for smoking cessation), and counseling to reduce stress, says Dr. Prasad. That means you’ll likely be working with a team of experts, including not just doctors or cardiologists, but also exercise physiologists, therapists, nurses, registered dietitians, and other clinicians who can help you reach your heart health goals.
“Programs vary in regards to format, but the core goal of cardiac recovery is the same: to help you get stronger following your cardiac event,” explains One Drop coach, Lisa Graham, a registered nurse (RN) and certified diabetes care and education specialist (CDCES).
Lack of Access to Cardiovascular Health and Cardiac Recovery Programs
Unfortunately, despite its well-researched benefits, cardiac rehab is often “underutilized,” and referral practices tend to be unequal, says Dr. Prasad. For example, researchers from UCLA analyzed data from more than 100,000 people with heart failure who were eligible for a cardiac rehab program between 2005 and 2015, and found that only one in 10 of these individuals were actually referred to a cardiac recovery program.
These disparities only grow larger when we look at referrals among women and minorities, notes Dr. Prasad. “Research shows that women are 12% less likely to receive referrals compared to men, and minorities are similarly less likely to be referred to cardiac rehab,” he explains. “Compared to non-minorities, Black people are 20% less likely to receive referrals, and Hispanic people are 36% less likely to be referred. These disparities are likely significant contributors to worse cardiovascular outcomes for women and minorities in the U.S.”
There may be multiple explanations for why these disparities exist, but what we do know with certainty is that they’re “unacceptable,” says Graham. “With women of color and minorities at a higher risk of heart disease, we need to make sure that we’re creating and promoting more education programs for these populations,” she explains. “The only way this is going to change is if we shine a light on the injustice and create opportunities to speak directly to these folks and teach them how to advocate for themselves when they interact with healthcare providers.” (Learn more about how to be your own advocate in a world of health disparities.)
However, this type of education goes both ways, notes Graham. “I believe that providers need education highlighting these disparities as well, including how they can address the importance of heart health and the need to refer their patients to cardiac rehabilitation,” she shares.
Fortunately, some people are actively fighting for better and more equal access to cardiac recovery programs. Back in March of 2021, Congress introduced a bipartisan bill in the House of Representatives that would expand access to cardiac recovery programs by reducing wait times for referrals and authorizing more physician assistants, nurse practitioners, and clinical nurse specialists to help supervise cardiac recovery care.
Phases of Cardiac Recovery
Cardiac recovery may follow a multifaceted approach, but that doesn’t mean overhauling your entire life in the course of a single day. According to Ford Brewer, MD, MPH, a board-certified preventive and occupational medicine specialist, there are typically four key phases to cardiac recovery.
Phase 1: Acute, In-Hospital Phase
Depending on the type of heart health incident you’re experiencing, this phase might last as little as one day—particularly if you’re only going in for an angiogram (an X-ray procedure that allows you to see your heart’s blood vessels) or other brief monitoring practices to rule out various cardiac problems—or as long as two to five days, especially if you’re recovering from something more serious, such as heart surgery or a heart attack. “The acute phase may last even longer for more severe problems, such as multiple heart attacks that result in heart pump failure,” notes Dr. Brewer.
Regardless of what brought you into the hospital, explains Dr. Brewer, the goal for this initial phase is to assess your situation with a precise diagnosis, including the root cause(s) of your heart health issues, and to assure your safety and understanding as you navigate the next steps in your recovery.
In terms of what those root causes could be, genetics can obviously be a crucial factor, says Dr. Brewer, but he also points to insulin resistance—which happens when the cells in your muscles, fat, and liver don’t respond to your body’s production of the hormone insulin and, as a result, can’t easily use glucose for energy, leaving you with chronically high blood sugar levels—as another potential catalyst.
“It’s easy to assume that it’s cholesterol causing a heart health problem, and while that very well might be the case, there’s also the issue of undiscovered prediabetes or diabetes, which can often be the underlying root cause of the cholesterol issue,” explains Dr. Brewer. Essentially, insulin resistance can lead to increased glucose levels, which can then lead to a condition called atherosclerosis, or a buildup of fats, cholesterol, and other substances in the artery walls that, ultimately, can cause problems with your heart.
No matter what the root cause turns out to be, for most people, this initial phase of cardiac recovery will mostly entail simple walking and breathing exercises. “Even walking can be a challenge and painful during this time,” says Dr. Brewer. “But it’s vital to get through this phase. Do everything possible to participate and cooperate with your doctor’s requests.”
Phase 2: Post-Discharge, Pre-Exercise Phase
By this point in your recovery, you might feel an urge to return to your routine and “get back to normal.” But, again, depending on what exactly prompted you to undergo cardiac recovery in the first place, you might still be having difficulty with basic skills like walking, let alone anything else.
With that in mind, this phase will likely focus on reinforcing what you learned in the first phase about your heart health condition and how to manage it. You’ll probably start getting into a routine of meeting and working with your cardiac recovery team, including visits with a nurse, cooking and nutrition classes with a registered dietitian, physical therapy sessions with an exercise physiologist, and even stress counseling with a mental health professional, among other possible clinical visits.
“Plus, no matter the type of cardiac event you’ve experienced, you’ve likely undergone a lot of changes in medications, too,” adds Dr. Brewer. “Even if there was nothing else to do in your recovery program, learning medications can be challenging. Couple that with daily walking, breathing exercises, dietary education—that’s now a set of challenges.” (Find out how One Drop Premium can help you organize your medication, daily meal planning, and more.)
Phase 3: More Education On Exercise, Diet, Sleep, and Overall Lifestyle
To be clear, you’ll probably start learning about various heart-healthy lifestyle skills almost immediately upon starting any cardiac recovery program. But most of us don’t start feeling “normal” about these changes until we’re well into this third phase, says Dr. Brewer, when those new skills start to develop into consistent habits. (Learn more about how to create habits that last in your self-care.)
“During this phase, we have to develop the discipline to make lifestyle changes,” he explains. “These include core behaviors, such as diet, exercise, sleep, and proper medication compliance. More often than not, we’ve delayed making these changes for years—perhaps even decades. This cardiac event may have provided the needed wake-up call and motivation to make these complex changes.”
At the same time, though, continues Dr. Brewer, it’s important to expect certain challenges along the way—namely, sleep troubles.
“Sleep disturbance can become a significant problem during this time, especially with more intense procedures or hospital stays,” he explains. “Sleep is crucial for recovery, and many people don’t necessarily expect the destructive spiral of poor sleep and anxiety.” Plus, lack of sleep can make it easier to overeat, setting you back further in your heart health goals.
Fortunately, the exercise component of your cardiac recovery can help you get some restful shut-eye, says Dr. Brewer. “Exercise, such as treadmill incline (or hill) walks and resistance training, usually helps you get better sleep,” he explains. Just remember to continue working closely with your cardiac recovery team on monitoring how exercise affects your heart health so you’re not pushing yourself too far. (Here are more tips for getting a good night’s sleep, including guidance on how to improve your nutrition for better sleep.)
Phase 4: Heart Health Maintenance
Keep in mind that it might take several days, weeks, months, or maybe even a year to complete the first three phases of cardiac recovery (and, for that matter, your experience might not fit neatly into these different phases). Everyone’s journey will look different.
That said, if you’ve completed the first three phases of cardiac recovery, that means you’ve probably spent a lot of time learning all the ins and outs of how to eat, exercise, sleep, and manage stress in ways that promote optimal heart health. Now, it’s up to you to carry those skills over to the fourth and final phase of cardiac recovery—a.k.a. your regular, everyday life.
“Whether you were hospitalized for a heart attack, stent procedure, or even major cardiac surgery, recovery does not end in the hospital or outpatient clinic,” explains Dr. Prasad. “Cardiac rehab equips you with the tools to lead a heart-healthy lifestyle, feel better and live longer, and reduce the risk of another cardiac event.”
Cardiac Recovery Isn’t Just About Rehabilitation—It’s About Prevention, Too
While it’s true that you might not experience a cardiac rehab program until you find yourself recovering from a heart-related health issue, the goal of these programs isn’t just to recover from one particular event. The real objective here is to learn sustainable ways to manage your heart health for the rest of your life so you can prevent problems down the road.
That means cardiac recovery doesn’t end when your program ends. Rather, it’s up to you to maintain your motivation in whichever way works best for you personally. Maybe you’ll journal about your progress and reflect back on those entries on your tough days, says Graham. Perhaps you’ll make a point to celebrate all of your wins, no matter how small, because you know they’re getting you where you need to be to reach your goals.
Whatever your approach is, you’re in charge now. And, no matter how good your cardiac recovery team may have been, you alone have the power to shape the path of your heart health. As Dr. Brewer says: “How you recover depends far more on you than your rehab medical team.”
This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations and program design at One Drop.