Dr Justin Bachmann Discusses Cardiac Rehabilitation in Patients

Only 20% of patients who have a heart attack undergo recommended cardiac rehabilitation, so cardiologists are looking at ways to encourage patients to go to rehab, explained Justin Bachmann, MD, MPH, FACC, instructor of Medicine and Health Policy at Vanderbilt University Medical Center.

Transcript (slightly modified)

What are your findings from your research on using behavioral interventions to improve care for patients with cardiovascular disease?

One of my major research focuses is cardio rehabilitation. So cardiac rehab is a program of prescribed exercise that patients should undergo after they have a heart attack, or undergo a bypass, or other cardio procedure. Unfortunately, only 20% of patients participate in cardiac rehabilitation in the United States. So we’re looking at behavioral intervention to encourage patients to go to cardiac rehab.

One of the things, and it was actually referenced in one of the talks at the [ACO & Emerging Healthcare Delivery Coalition fall meeting], was the concept of self-efficacy. At the conference it was discussed in the context of physician burnout. Here, I’m actually talking about it in regards to patients. Self-efficacy is a psychological construct. It’s basically the confidence that a patient has and their ability to achieve a desired outcome, a specific task. So the confidence that a patient has and their ability to start exercising, stop smoking, control their blood pressure, take their medicines.

Unfortunately, a lot of the elderly patients that I see in the hospital and have heart attacks they’re very ill and their self-efficacy levels for various attacks are not very high; I mean they’re ill and perhaps some of them haven’t exercised perhaps some of them have been smoking all their lives. What we, traditionally, have done in medicine is tell patients things: cholesterol is bad, stop smoking, exercise. It’s important to provide information but it’s also important to support patients and give them the confidence and the information they need to achieve these outcomes. That’s what my research program is focused on.

We use such techniques as emotional interviewing which is basically a counseling technique devised by Stephen Rollnick, PhD, and William Richard Miller, PhD, a couple of psychologists, to give them patience and earn confidence to do these sorts of things. And I think really we know that these results are sort of preliminary, but they’re very important to patients who have had cardiac events and getting them to cardiac rehabilitation programs and rehabilitate after they have heart attacks or undergo bypasses.