Cardiac rehabilitation is already proven to help patients who survive a myocardial infarction, but a new JACC study suggests that type 2 MI patients are referred for rehab far less often than type 1 MI patients, even if the patients themselves would gladly go.
- Type 1 MIs are far more common (75-85% of MIs) and happen when a blood clot forms in the coronary artery.
- However, type 2 MI (supply-demand mismatch) carries higher all-cause mortality than type 1, largely due to comorbidities like CKD, COPD, and cancer.
- Thus, type 2 MI patients typically receive less overall cardiac care, since they’re usually someone else’s patient before a cardiologist sees them.
But a heart attack is a heart attack, and proper rehab after both type 1 and 2 is critical for recovery. To determine the rehab referral rate for type 2 patients compared to type 1, MGB researchers paired a survey of 118 clinicians with one of 50 inpatients who had a type 2 MI and found…
- Only 30% of clinicians said they “always” or “often” refer patients to rehab after type 2 MI.
- Meanwhile, 80% said they refer to rehab after type 1 MI (a substantial 50-point gap).
- Fewer clinicians perceived cardiac rehab as beneficial for type 2 MI (69% vs. 98%).
- Curiously, most clinicians still rated cardiac rehab safe for both MI types (93% vs. 99%).
That means the rehab referral gap is both significant and clinician-driven. The good news is that the study also looked at what causes these referral barriers, and it’s more about knowledge gaps than safety.
- The top reason clinicians listed for not referring type 2 MI patients was lack of awareness of their rehab eligibility (35%), followed by patient preference and comorbidities.
- Moreover, roughly 1 in 5 clinicians said they were unfamiliar with the referral process for type 2 MI, while nearly a quarter wanted more evidence that rehab helps these patients.
Speaking of patients, researchers surveyed type 2 MI patients as well, finding that perspectives on undergoing cardiac rehab are overwhelmingly willing.
- 90% believed rehab would benefit their health.
- 80% felt it would make returning to activity safer
- 82% said they’d likely attend if referred.
- Notably, home-based (54%) and hybrid (50%) rehab formats were preferred over in-person.
The Takeaway
With both evidence and guidelines backing cardiac rehab for the two types of MI, this study clarifies that it’s more of an educational barrier than a safety one that decreases type 2 MI patient referrals. With more data and better messaging, this trend could change.
