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Wednesday, August 24, 2016

Cancer on Course to Become Americans' Top Killer

Cancer on Course to Become Americans' Top Killer

Report shows it will probably eclipse heart disease as leading cause of death in coming years

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, Aug. 24, 2016 (HealthDay News) -- Cancer is on track to become the leading cause of death in the United States, closing in on heart disease as America's number one killer, a new government study shows.

Heart disease has consistently been the leading cause of death for decades, and remained so in 2014, according to a report from the National Center for Health Statistics (NCHS) at the U.S. Centers for Disease Control and Prevention.

But the gap between heart disease and the second-leading cause of death, cancer, has been narrowing since 1968, the researchers said.

Cancer actually surpassed heart disease as the leading cause of death for 22 states in 2014, the study found. Back in 2000, Alaska and Minnesota were the only two states where cancer killed more people than heart disease.

In addition, cancer is now the leading cause of death for a number of minority groups, including Hispanics, Asians and Pacific Islanders, the report showed.

"It's been edging this way for a while," said co-author Robert Anderson, chief of the Mortality Statistics Branch at the NCHS. "We've taken for granted that heart disease is the leading cause of death, but now because of prevention efforts and advances in treatment, we're making substantial progress with heart disease, to the point where now it's roughly on par with cancer."

Annual heart disease deaths have decreased nationwide from a peak of just over 771,000 in 1985 to nearly 597,000 in 2011. In the meantime, cancer deaths have nearly tripled from just under 211,000 in 1950 to almost 577,000 in 2011, the report stated.

Dr. Mariell Jessup is a spokeswoman for the American Heart Association. She pointed out that new medicines have made it easier for people to control their blood pressure and cholesterol, treatment advances like angioplasty and heart bypass surgery saves the lives of many heart patients, and more people have quit smoking and started eating healthier diets.

"One could argue that we're doing a better job of keeping people with heart disease alive," said Jessup, who is a professor at the Hospital of the University of Pennsylvania in Philadelphia. "It's not that people aren't experiencing heart disease, but they're not dying from it."

Report shows it will probably eclipse heart disease as leading cause of death in coming years


Another expert agreed, with a twist on the thinking.

Essentially, modern medicine has gotten so good at dealing with heart disease that people are living much longer, making them more apt to eventually develop cancer, said Dr. Richard Schilsky. He is chief medical officer for the American Society of Clinical Oncology.

"We have to keep in mind that everyone's going to die eventually from something. Any time we reduce the risk of death for any particular cause, we increase the risk you're going to die from another cause," Schilsky explained.

"Cancer is a disease that is fundamentally associated with aging. If you outlive all the competing causes of mortality, there's a greater and greater likelihood that you're going to get cancer," Schilsky added.

That view is reflected in the states where cancer has overtaken heart disease, said Rebecca Siegel, strategic director of Surveillance Information Services for the American Cancer Society.

In those states, people seem to be healthier overall than in states where heart disease reigns supreme. Death rates for both heart disease and cancer were lower in the states where cancer was the leading cause of death, Siegel said.

"It's not that cancer rates are high in those states at all," Siegel said. "We all have to die from something, right?"

She added that heart disease treatment and prevention has benefited from rapid progress because it's a more narrow field of medicine.

"Heart disease is basically one disease, whereas with cancer we're looking at more than 100 different diseases," she said. "You have very effective ways to prevent and treat heart disease, and we've had them for quite some time, whereas knowledge about the biology of cancer and how to prevent it and treat it is still in its infancy."

In recent years -- between 2011 and 2014 -- heart disease and cancer deaths have both increased in roughly parallel fashion, the report noted.

Heart disease deaths increased by 3 percent between 2011 and 2014, from 596,577 to 614,348, while cancer deaths increased by 2.6 percent during the same period, from 576,691 to 591,699, the findings showed.

Report shows it will probably eclipse heart disease as leading cause of death in coming years


These increases could be related to the obesity epidemic, Siegel suggested.

"The obesity epidemic is catching up with us," she said. "It's overcoming our ability to prevent and treat heart disease, and there are a lot of cancers that are also associated with obesity."

The report was published online Aug. 24 in the CDC's NCHS Data Brief.

AHA Says Cap Added Sugars for Kids at 6 Teaspoons a Day

AHA Says Cap Added Sugars for Kids at 6 Teaspoons a Day

AHA Says Cap Added Sugars for Kids at 6 Teaspoons a Day

Children should consume less than 25 g, or the equivalent of 6 tsp, of added sugars a day — far below current intake in the United States, according to the first scientific statement on the subject by the American Heart Association (AHA).

Currently, US children ages 2 to 19 years old consume more than three times that amount — about 80 g of added sugar daily — half from food and half from drinks, say the diet and nutrition experts who analyzed National Health and Nutrition Examination Survey data from 2009–2012. And because intake amounts in the surveys were self-reported, the numbers likely even underestimate the problem, the authors of the statement say.

Added sugars include table sugar, fructose, and honey used in processing and preparing foods or drinks and sugars added to foods at the table or eaten separately.

Only 8 Oz of Sugary Drinks a Week, Guidelines Say

Miriam B Vos, MD, MsPH, associate professor of pediatrics at Emory University School of Medicine, Atlanta, Georgia, and fellow committee members write in the statement published August 22 in Circulation: "Current evidence supports the associations of added sugars with increased energy intake, increased adiposity, increased central adiposity, and increased dyslipidemia."

They add that overweight children who continue to ingest more added sugars are also more likely to become insulin-resistant, a precursor for type 2 diabetes.

Beginning July 2018, the Food and Drug Administration (FDA) will require that food labels show not just all sugars but also those that were added.

"Until then, the best way to avoid added sugars in your child's diet is to serve mostly foods that are high in nutrition, such as fruits, vegetables, whole grains, low-fat dairy products, lean meat, poultry, and fish and to limit foods with little nutritional value," Dr Vos said in a press statement.

In addition to limiting intake of table sugar, fructose, and honey, people should watch for labels for brown sugar, corn sweetener, corn syrup, dextrose, glucose, invert sugar, lactose, malt syrup, maltose, molasses, sucrose, trehalose, and turbinado sugar, the AHA suggests.

One of the biggest sources of added sugars is sugar-sweetened beverages, particularly soft drinks, sweet tea, and sports and energy drinks.

The AHA cautions that children and teens should have no more than 8 oz weekly of sugar-sweetened drinks. Parents should avoid all added sugar for children under the age of 2 years. Calorie requirements are only about 1000 a day for infants, so there is less room for added low-value sugars. Also, taste preferences start early in life, so limiting added sugars may help develop healthy eating habits.

"Children should not drink more than one 8-oz sugar-sweetened drink a week, yet they are currently drinking their age in sugary drink servings each and every week," Dr Vos commented.

As to whether using artificial sweeteners such as aspartame, saccharine, and sucralose may be a good solution, the authors point to a dearth of research in that area for both child and adult populations and therefore could not offer a recommendation.

Further research is also needed into the genetic component of bodies' response to sugar and how the interaction between the microbiome and added sugars and consequently CVD risk varies among individuals, the authors suggest.

The AHA guidelines align with the World Health Organization and the Food and Drug Administration recommendations that added sugars should make up less than 10% of calories.

Dr Vos has no relevant financial relationships. Disclosures for the coauthors are listed in the article.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

Circulation. Published online August 22, 2016. Abstract

Sunday, August 21, 2016

Why You Should Never Tell Someone to Relax - WSJ

Why You Should Never Tell Someone to Relax - WSJ

Why You Should Never Tell Someone to Relax

It's a paradoxical fact: When someone is getting stressed out, one of the least effective (and perhaps most annoying) things to say is "Relax."

The directive has exactly the opposite effect on most people. People who instruct a colleague, subordinate or loved one to relax may have good intentions. But it is usually better to resist ordering people to change their emotional state and try a different strategy. If you are on the receiving end of an order to relax, there are countermoves that can keep your blood pressure from soaring higher.

Anna Runyan was working hard on a previous job as a consultant several years ago when her boss approached her desk and told her to relax, adding, "you don't have to be perfect," says Ms. Runyan of San Diego.

Anna Runyan of San Diego felt angry when a former boss told her to ​​stop working so hard, suggesting that he didn't understand what she faced.

Anna Runyan of San Diego felt angry when a former boss told her to ​​stop working so hard, suggesting that he didn't understand what she faced.Photo: Evan Yamada Productions


She felt her face flush with anger. She wanted some acknowledgment of her hard work and tight deadlines, but "he really didn't understand all the things I was doing," says Ms. Runyan, founder of ClassyCareerGirl.com, a career and business site for women. "I wanted to shut down." Afterward, she tried updating her boss more frequently on her workload but left the company the following year.

Relaxing on command is physiologically impossible if "the body is already too acutely stressed to turn it around," says Wendy Mendes, a professor of emotion at the University of California, San Francisco, and a researcher on stress. While the body responds rapidly to stress, returning to a relaxed state can take 20 to 60 minutes, she says.

Other research shows that trying to hide or suppress an emotion, called "emotion suppression," typically backfires. When people are told to hide how they feel and try to clamp down on the emotion, "it actually leaks out more," Dr. Mendes says.

Such misfires can open a deep divide between an employee and a boss. Brandon Smith was extremely stressed on a previous job as a retailing manager years ago, after his boss ordered him on his first day to start laying off several co-workers, says Mr. Smith, now an adjunct professor of business at Emory University in Atlanta.

Brandon Smith of Atlanta ​says a former boss's dismissive remark that laying off co-workers wasn't a 'big deal' motivated him to build a new career as an executive coach. Photo: Allison Shirreffs

When his boss passed his desk and remarked "just settle down, it's not a big deal," Mr. Smith says, "I wanted to explode with anger." He was so shaken that he emerged with a new career purpose. After leaving that job, he earned two master's degrees, in clinical therapy and business, and became an executive coach and team-building consultant, says Mr. Smith, founder of TheWorkplaceTherapist.com.

Advising someone to relax can mask a variety of motives. The underlying message may be, "I can't stand the way you're making me feel, so stop it," says Joseph Burgo, a clinical psychologist and writer best known for his work on narcissism.

If it is a loved one giving the order to relax, it may reflect a genuine need—for instance, for calm time together. Nina Batson of Tinton Falls, N.J., sometimes rushes to get laundry and other housework done in the evening after work. If her 13-year-old daughter Tati tells her, "Oh, Mom, relax, slow down," Ms. Batson stops to watch TV with her for a while, talk, laugh and have a cup of tea, even though she knows it will take her longer to finish the chores.

Left: 'Calm down!' can be well meant, but when a boss makes this command, an employee can feel even more stressed as well as defensive or angry. Right: Open-ended questions like 'How's it going?' or 'Would you like to talk?' invite the employee to describe the pressures she is under, helping her to shake her stress and feel better. Illustration: Tim Bower for The Wall Street Journal

If you're criticized for appearing stressed, pause and take a deep breath before responding, says Debra Burdick, an Enfield, Conn., speaker and author of books on mindfulness. Try not to take it personally, and regard it as a cue to address the underlying problems.

Consider starting a conversation about reducing the causes of stress, says Jordan Friedman, a New York City stress coach. Acknowledge that you're feeling the strain, and then add, "It would be great if we could sit down at the beginning of next week and figure out how to make this process less stressful for me and everyone else."

Also, take a moment to "hold up a mirror and take a look" at whether your style of working might be stressful to others, says Nancy Ancowitz, a New York City presentation and career coach. If so, say thanks for the feedback, and try reducing stress through exercise, more frequent breaks, deep breathing or other techniques.

New York City graduate student ​Adam Ma says a professor's order to 'calm down' before giving a major presentation ​unnerved him at first​ but helped him perform better in the end​. Photo: Adam Ma

Embracing more realistic expectations of yourself can help in some situations. Adam Ma of New York City, a graduate student whose first language is Mandarin, was extremely nervous several years ago when he stepped up to give a presentation to 40 fellow students. He wanted his English to be perfect, and he had memorized rigid rules about maintaining good posture and constant eye contact with listeners. When his professor told him in front of the whole class to "calm down," Mr. Ma says, at first, "it just made me feel worse."

But then, "I decided to adjust my expectations to be more comfortable," he says. He allowed himself to use his notes and to pause now and then to look away from the audience, have a sip of water and take a breath. "I felt such relief," he says. He felt he made an emotional connection with listeners, who applauded warmly, and he scored an A for the course.

Mr. Ma, who also works full-time as a project and process manager, says telling colleagues before making a presentation that he is feeling stressed helps him relax and "helps prepare people for what they're going to get and how they can help me," he says. "And probably, people will make a couple of jokes, and we will have some laughs."

To help calm someone who is stressed, acknowledge his or her feelings first by saying, "Looks like you're having a tough day," Ms. Ancowitz says. Show empathy and ask open-ended questions such as "Tell me what's going on," to give the person a chance to talk about his or her feelings. You could acknowledge that it's been a stressful time for everybody, saying, "Other people are feeling the pressure too. Let's try to figure this out as a group," Mr. Friedman says. If a discussion is getting heated, suggest taking a break for a walk, a cup of coffee or lunch.

In New York City, Glenn Chiarello, who has been a dentist for 30 years, says he never tells his patients to relax, even though most new ones are nervous. "Instead, I become inquisitive. 'How do you feel about having this work done today?' " he says. Most patients start talking, and as he listens, "they do in fact do what we want them to do: They start to relax."

Write to Sue Shellenbarger at sue.shellenbarger@wsj.com

What should I do if I feel a fluttering feeling in my chest? Here's some advice from an expert

What should I do if I feel a fluttering feeling in my chest? Here's some advice from an expert

What should I do if I feel a fluttering feeling in my chest? Here's some advice from an expert

HEART PALPITATIONS CAN be alarming, a nuisance and can feel very unpleasant. But when should you start to worry?

Palpitations are often described as a fluttering feeling in the chest or a sensation of the heart racing or pounding. Sometimes you may feel skips and jumps, like missed or extra beats. This can last for anything from seconds to hours or even days.

Palpitations describe the feeling of your heartbeat or an awareness of a change in your heart rhythm. Most of the time we are completely unaware of our heart beating.

Palpitations are very common, and most people can experience them from time to time. In most cases they are harmless and not a sign of heart problems.

But accompanied by other symptoms, such as dizziness, fainting or tightness in your chest, they can sometimes be a sign of a heart problem and may need further investigation.

What causes palpitations?

Palpitations are a common occurrence and usually nothing to worry about, yet the cause is often unknown. Certain situations and lifestyle factors can trigger palpitations or cause them to occur more frequently.

Common triggers include:

  • Strenuous exercise
  • Surges of adrenaline, a hormone released in response to strong emotions like anxiety, excitement and stress
  • Cigarette smoking due to the stimulating effect of nicotine
  • Excessive consumption of tea or coffee due to the stimulating effect of caffeine
  • Drinking excessive amounts of alcohol or eating rich, spicy foods
  • Using recreational drugs
  • Illness such as colds or flu and fever

Less common triggers:

  • Hormone changes associated with menstruation, pregnancy or menopause
  • Side effects from some types of medication e.g. some asthma inhaler medications that contain stimulants; some cold and cough remedies
  • Palpitations can sometimes be associated with some medical conditions which can make the heart beat faster, stronger or irregularly. These include an overactive thyroid, a low blood sugar level, anaemia (a low blood count), and an abnormal heart rhythm (arrhythmia).

What do I need to do?
Palpitations that occur just occasionally and last a few seconds usually don't need any investigation or treatment.

If you are concerned about your palpitations, it is sensible to go and see your GP, particularly if they happen on a frequent basis.

Unless your doctor finds that you have a heart condition, they rarely need treatment. Instead, your doctor may recommend ways for you to avoid the triggers that cause your palpitations.

If you have a history of heart disease, your palpitations become more frequent or they worsen, or they are accompanied by other symptoms, see your doctor. You may have a heart rhythm problem (arrhythmia), such as atrial fibrillation (a fib) or supraventricular tachycardia (SVT). Further tests may be needed to assess your heart rate and rhythm.

If your palpitations are caused by an arrhythmia, your treatment will focus on correcting the underlying condition.

A fib is one of the most common heart rhythm problems causing a fast, irregular pulse. It is generally not life threatening, but is a major cause of stroke and will usually require treatment.

SVT is an abnormally fast heart rate which is usually steady and regular. Episodes are usually harmless and often settle down on their own without treatment.

Tips to reduce common triggers

  • Stay well hydrated when exercising
  • Reduce stress and anxiety. Try relaxation techniques such as meditation, yoga, mindfulness
  • Avoid stimulants like excess alcohol, nicotine and some cold and flu remedies
  • Reduce caffeine drinks like tea, coffee and energy drinks
  • Avoid recreational drugs

For more information on heart health, visit the Irish Heart Foundation's website.

Patricia Hall is the Irish Heart Foundation's Helpline Nurse Manager.

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Tuesday, August 16, 2016

New FDA-Approved Medication, ARNI Therapy, Could Prevent Nearly 30,000 Deaths From Heart Failure

New FDA-Approved Medication, ARNI Therapy, Could Prevent Nearly 30,000 Deaths From Heart Failure

New FDA-Approved Medication, ARNI Therapy, Could Prevent Nearly 30,000 Deaths From Heart Failure

A new FDA-approved class of cardiovascular medication could save thousands of heart failure patients from dying each year in the United States, according to a recent study published in JAMA Cardiology.

Heart failure occurs when the heart no longer pumps blood as well as it should. This illness, which usually develops after other conditions have damaged or weakened the heart, affects about 5.7 million adults in the U.S., according to the Centers for Disease Control and Prevention. However, 2.7 million people with heart failure have also been diagnosed with reduced ejection fraction — the heart muscle does not contract effectively and less oxygen-rich blood is pumped out to the body. Doctors use the heart's ejection to essentially diagnose and track heart failure. And with this new medication, ARNI therapy using a combination drug of valsartan/sacubitril called Entresto, doctors could also enhance the body's protective hormonal systems while simultaneously inhibiting the overactive hormones that harm the heart.

Heart failure New heart failure therapy could prevent thousands of deaths each year in the U.S., finds study. Pixabay

Although previous studies have shown that this heart failure therapy can reduce mortality in heart failure patients, researchers wanted to quantify the deaths that were prevented or postponed with ARNI therapy. To do this, they analyzed published data of patients who were eligible for the therapy. They also looked at population-based estimates of people with heart failure and reduced ejection fraction, as well as those who needed to be treated with medication in order to avert or delay death.

Researchers found that of the 2.7 million people diagnosed with heart failure with reduced ejection fraction, 84 percent were potential candidates for ARNI therapy. Their analysis also showed that if most, if not all, eligible patients received ARNI therapy, it could potentially prevent approximately 28,484 deaths each year in the U.S.

"We have demonstrated the potential gains that may be achieved with the application of ARNI therapy for patients with [heart failure and reduced ejection fraction] in the United States," researchers wrote. "Given the substantial [heart failure] burden and potential benefits of implementation for preventing deaths, efforts to ensure comprehensive implementation of ARNI therapy should be considered."

Heart failure can't be cured, but it can be treated and managed with exercise, a healthy diet and lifestyle. This may include eating less salt, weight loss and smoking cessation.

Source: Fonarrow G, Hernandez A, Solomon S, Yancy C. Potential Mortality Reduction With Optimal Implementation of Angiotensin Receptor Neprilysin Inhibitor Therapy in Heart Failure. JAMA Cardiology. 2016.

Monday, August 15, 2016

Heart disease and cancer are responsible for nearly half of all deaths in the U.S., report says - LA Times

Heart disease and cancer are responsible for nearly half of all deaths in the U.S., report says

What are the most common ways to die in America? The answer depends on how old you are, whether you're a man or a woman, and your racial and ethnic background, a new report shows.

Alzheimer's disease accounted for 5% of deaths among U.S. women, for instance, but only 2.1% of deaths among men. Accidents and unintentional injuries caused 39.7% of deaths among people between the ages of 10 and 24, but only 7.4% of deaths for adults between the ages of 45 and 64. Diabetes was responsible for 4.3% of African American deaths and 2.7% of white deaths.

Overall, heart disease was the No. 1 cause of death for Americans, killing 614,348 people in 2014, according to a government analysis of all death certificates filed in the country that year. Cancer came in second, causing 591,699 deaths. Together, the two diseases accounted for 45.9% of all deaths in the U.S., the report says.

Heart disease and cancer have long topped the list of leading causes of death, and each killed a few thousand more people in 2014 than in 2013. However, while cancer held steady at 22.5% of all deaths in the U.S., the proportion of deaths due to heart disease fell slightly, from 23.5% in 2013 to 23.4% in 2014.

The next three leading causes of death — chronic lower respiratory diseases, accidents and unintentional injuries, and stroke — accounted for 15.8% of U.S. deaths in 2014. Alzheimer's, diabetes, influenza and pneumonia, kidney disease and suicide rounded out the top 10. Combined, they were responsible for 12% of fatalities that year.

Among the 10 leading causes of death, eight — Alzheimer's, accidents, suicides, strokes, kidney disease, cancer, diabetes and heart disease — killed more people in 2014 than in 2013. By far, the biggest jump was for Alzheimer's, which caused 10.5% more deaths in 2014 compared with the previous year.

Meanwhile, deadly cases of flu and pneumonia fell 3.1%, and deaths from chronic lower respiratory diseases fell by 1.4%.

Heart disease and cancer ranked No. 1 and No. 2 for both men and women, but both killed a slightly greater proportion of men than women. For women, respiratory diseases ranked third, followed by stroke and Alzheimer's. For men, accidents were the third-leading cause of death, followed by respiratory diseases and stroke.

Accidents and unintentional injuries were the leading cause of death for children, teens and younger adults. Cancer took over as the leading cause of death among those 45 and older. Cancer deaths were surpassed by deaths due to heart disease at 65.

Breaking down the death certificate statistics according to race revealed that seven of the leading causes of death were shared by whites, blacks, Asians and Native Americans. Cancer was the No. 1 killer of Asian Americans, accounting for 26.8% of deaths in 2014. For the other three groups, the top killer was heart disease, which was responsible for 23.7% of deaths among blacks, 23.4% of deaths among whites and 18.3% of deaths among Native Americans.

Alzheimer's disease was among the top 10 killers for blacks, whites and Asians, but not for Native Americans. Suicide and influenza and pneumonia were on the list for Asians, whites and Native Americans, but not for blacks. However, African Americans were alone in having homicide and the bloodstream infection septicemia among the leading causes of death.

Latinos had a lower proportion of deaths due to heart disease and cancer than did non-Hispanic blacks and non-Hispanic whites, according to the report. They also had a greater burden of accident-related deaths, which ranked third, and of chronic liver disease and cirrhosis, which ranked sixth.

The No. 1 cause of infant deaths was congenital malformations, deformations and chromosomal abnormalities, which accounted for 20.4% of deaths among children under a year old. Close behind were deaths due to premature birth and low birth weight, at 18%. Maternal complications during pregnancy, sudden infant death syndrome and accidents completed the top five causes of infant deaths.

These were the top 10 causes of death for all Americans in 2014, along with their contribution to overall deaths:

  1. Heart disease (23.4%)
  2. Cancer (22.5%)
  3. Chronic lower respiratory diseases (5.6%)
  4. Accidents/unintentional injuries (5.2%)
  5. Stroke/cerebrovascular disease (5.1%)
  6. Alzheimer's disease (3.6%)
  7. Diabetes (2.9%)
  8. Influenza and pneumonia (2.1%)
  9. Kidney disease (1.8%)
  10. Suicide/intentional self-harm (1.6)

The report was compiled by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.


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Cardiac Rehab Saves Lives. So Why Don't More Heart Patients Sign Up? : Shots - Health News : NPR

Cardiac Rehab Saves Lives. So Why Don't More Heart Patients Sign Up? : Shots - Health News : NPR

Cardiac Rehab Saves Lives. So Why Don't More Heart Patients Sign Up?

Exercise physiologist Courtney Conners checks Mario Oikonomides' vital signs before his cardiac rehab workout at the University of Virginia Health System clinic.

Exercise physiologist Courtney Conners checks Mario Oikonomides' vital signs before his cardiac rehab workout at the University of Virginia Health System clinic.

Francis Ying/Kaiser Health News

When Mario Oikonomides was 38 years old he had a massive heart attack. About a month later, after he'd recuperated from the emergency, his doctors sent him to a cardiac rehabilitation program, where he learned about the role physical activity can play in reducing cardiac risk.

"I never exercised before," Oikonomides says. "I became addicted to exercising." The program, overseen by a medical team, also checked up on his medications, provided nutrition counseling and offered other help and coaching in the fraught weeks and months after his hospitalization.

Oikonomides is 69 now and lives in Charlottesville, Va. When he recently needed bypass surgery, long decades after that heart attack, he again signed up for a rehabilitation program as soon as he could.

"I bought myself 30 years of healthy life as a result of cardiac rehab," he says.

But, despite many years of research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer, Oikonomides is among a minority of patients who take advantage of such programs; fewer than a third do.

Why is rehab such a hard sell? Blame it on a number of factors, doctors say.

Some patients have to travel a long way to the nearest program; work schedules keep others from joining. Uninsured patients often can't afford it. And even those with insurance can be stopped short by copayments that can be $20, $40 — or even $50 a class.

"The number one barrier is the cost of the copay, which is frustrating," says Dr. Ellen Keeley, a cardiologist at the University of Virginia Health System.

These days, Medicare and most private insurers cover cardiac rehab for patients who have had heart attacks, coronary bypass surgery, or who have had stents implanted or received a diagnosis of heart failure or any of several other conditions. Most plans cover two or three hour-long visits per week — up to 36 sessions. With most programs encouraging patients to participate two or three days a week, the cost of copayments can add up fast.

Courtney Conners is an exercise physiologist at U.Va. who meets with patients after a heart attack. The U.Va. clinic, started by Keeley about a year ago, contacts patients before they are discharged and brings them back to the clinic a week or 10 days later to meet one-on-one with a nutritionist, pharmacist, cardiologist and exercise physiologist to develop a tailored rehab program.

"There's a little hesitance, where they're like, 'I don't really want to come. I don't know if I want to go three days a week,'" Conners says of the exercise program. "And then their wife, or one of their family members will push them, and then they'll agree to sign up."

Charles Greiner gets his heart rate up — with supervision — at the U.Va. cardiac rehabilitation gym in Charlottesville, Va.

Charles Greiner gets his heart rate up — with supervision — at the U.Va. cardiac rehabilitation gym in Charlottesville, Va.

Francis Ying/Kaiser Health News

Right now, there actually aren't enough rehab programs in the U.S. to accommodate all the patients who are eligible, advocates say. A recent study in the Journal of Cardiopulmonary Rehabilitation and Prevention surveyed 812 existing cardiac rehab programs across the nation and found that even if they were expanded modestly and operated at capacity, the existing programs could serve only 47 percent of qualifying patients.

Still, advocates are hopeful that cardiac rehab may start to gain more traction, now that hospitals have an extra incentive to encourage patients to sign up. Because of provisions in the Affordable Care Act, hospitals now face financial penalties if too many of their cardiac patients need to be readmitted soon after discharge — and enrolling patients in rehab helps keep those numbers down, the evidence shows.

For example, getting patients into cardiac rehab programs cut hospital re-admissions by 31 percent in one Canadian study, according to a review of the literature by the American Hospital Association, saving $8.5 million a year; a study in Vermont pegged the savings at about $900 per patient.

Kathryn Shiflett, a hospital phlebotomist and one of Keeley's patients, is just 33 and has two young kids. A week after her heart attack she was at the U.Va. clinic looking for information about a rehab program. She's eager to get well. But she's not used to exercise and she's a bit nervous about cardiac rehab.

After being reassured that her vital signs would be monitored closely as she exercised, Shiflett hinted at the real barrier: She lives an hour away and is about to start a new job. Cardiac rehab classes happen Mondays, Wednesdays and Fridays, with sessions at 8 a.m., 10 a.m. and 3 p.m.

Just a week after her heart attack, Kathyrn Shiflett meets with Dr. Ellen Keeley, a U.Va. cardiologist, to learn more about the next steps in healing.

Just a week after her heart attack, Kathyrn Shiflett meets with Dr. Ellen Keeley, a U.Va. cardiologist, to learn more about the next steps in healing.

Francis Ying/Kaiser Health News

"I don't know if I can get there by then," Shiflett says. "My job goes from 4:30 in the morning until 3."

Oikonomides says there was no question that he would do whatever it took to participate in rehab after his bypass surgery this winter. Cardiac rehab sparked his love of exercise, he says — and that has helped keep him out of the hospital for decades.