According to the new Heart and Stroke Foundation 2014 Report on the Health of Canadians, there are more Canadians surviving a heart attack or stroke than ever before. But, the Report also showed that a major scare, like a heart attack or stroke, doesn’t always lead to survivors being able to make and maintain potentially life-saving behaviour changes.
Over the last 60 years, the death rate has declined by more than 75 per cent with nearly 40 per cent of this decrease occurring in the last decade. This means that now, more than 90 per cent of Canadians who have a heart attack and more than 80 per cent who have a stroke and make it to the hospital will survive. Last year alone, there were 165,000 survivors of heart disease or stroke. While this is great news, and certainly cause for celebration, much work remains to be done.
As part of the Report, the Foundation conducted a poll of 2,000 heart attack and stroke survivors (and loved ones who were able to answer on their behalf), to learn about their health behaviours before and after a heart attack or stroke. The poll revealed that when it comes to physical activity, managing stress and maintaining a healthy weight, survivors are struggling to make and maintain these important healthy changes. Of those who needed to make these changes, more than 50 per cent couldn’t maintain the change or didn’t try at all. This is despite the fact that six in 10 survivors equate surviving with being given a second chance and no longer taking their health for granted.
“We cannot control all the factors that put us at risk for cardiovascular disease, but there are healthy changes people can make to largely prevent them from having a heart attack or stroke in the first place, including eating a healthy diet, being physically active, being smoke-free, managing stress and limiting alcohol consumption,” says Dr. Beth Abramson, Heart and Stroke Foundation spokesperson and author of Heart Health for Canadians. “And for people living with cardiovascular disease, these healthy behaviours are especially important and could prevent them from landing back in the hospital. But we need more research, more education, and an environment that supports these healthy behaviours.”
Survivors Face Barriers to Change
The poll illustrates how survivors face many barriers in making and maintaining changes, the biggest of which is related to motivation, which is defined as a lack of interest, a feeling that the goals are unrealistic and that there is too much change required all at once. Lack of motivation can indicate anxiety, depression and a perceived lack of control over the illness.
Heart disease and stroke can affect anyone. Even an athlete, like Olympic figure skater Isabelle Brasseur, has been personally affected and has lessons to share. “I know first-hand the importance of maintaining heart-healthy behaviours. I have a congenital heart condition which has caused my heart to stop, so I have had to take steps to control my health as best I could. I lost my father and my father-in-law to heart disease, and my mother has suffered two strokes, so I understand the pain that is associated with heart disease and stroke. My best advice is to identify early on everything you can do to reduce your risk and follow the advice of the Heart and Stroke Foundation, which is working hard to keep Canadians healthy.”
The good news, according to our poll, is that seven in 10 survivors feel they are at least living a little healthier since their heart attack or stroke. The areas where survivors report the most success in making and maintaining healthy changes include eating healthier, quitting smoking and reducing alcohol consumption. However, this also means that there are many survivors who need more help to make healthy changes, or who would benefit from assistance to get them started on a healthy path. In fact, the poll showed that two in 10 feel their lifestyle has not changed compared to before their event and one in 10 feel they are less healthy than before their event.
In addition to motivation, the poll outlined that other barriers posing challenges to survivors include:
• Not understanding what changes need to be made or how to make them.
• Challenges in physical or cognitive abilities since the event.
• Financial barriers, such as the costs of healthier foods and being physically active.
• Time constraints, including not enough time to exercise, or plan and prepare healthy meals.
The poll also revealed the vital role that family and friends play in a survivor’s recovery. More than eight in 10 survivors feel that their family support had a positive impact on them achieving a healthy lifestyle.
Nadia Bender, a 46-year-old fitness instructor and heart attack survivor knows the importance of family in the recovery process: “I relied on my family for so much during my recovery – from daily chores, to helping out with my three kids – I simply didn’t have the energy and stamina for it all. Their support also helped with my mental health and kept my stress levels in check, two important components of recovery.”
Ensuring Canadians who experience a cardiac event or stroke survive is paramount, but this is only the first step in what can be a long journey back home, and back to a better state of health. Family support can make a difference as can cardiac and stroke rehabilitation.
The Role of Rehabilitation
Rehabilitation plays a critical role in improving outcomes for heart attack and stroke survivors. It is well established that cardiac rehabilitation lowers mortality by as much as 25 per cent and improves the health of those who participate by helping them make healthy changes and stick to them. Rehabilitation programs provide support directly linked to behaviour change related to controllable risk factors.
“We know rehabilitation works. The number one benefit of rehabilitation is that it keeps survivors surviving. It also makes people feel better, improves their quality of life, and reduces hospital re-admissions as well as costs to the healthcare system,” says Dr. Neville Suskin, Medical Director, Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care London, Ontario.
However, not all survivors who could benefit from rehab are able to access a program. Evidence shows that only about one-third of cardiac survivors who are eligible for rehabilitation are referred to a program, and only 19 per cent of all stroke patients are discharged from acute care to a rehabilitation facility.
Creating More Survivors
Although we’ve made great progress and have created more survivors than ever before, there is more work to be done. We can’t lose sight of the fact that there are still 350,000 hospitalizations annually due to heart disease and stroke. Each year, about 50,000 new cases of heart failure are diagnosed, 70,000 heart attacks occur, and 50,000 strokes send Canadians to emergency rooms across the country. And there is still room for improvement to help the 1.6 million people currently living with heart disease and stroke recover to the fullest extent possible.
“As a community, we have learned so much over the years about heart disease and stroke. We are proud that Foundation-funded research and advocacy efforts have contributed to the decline in the death rate from cardiovascular disease. This ranges from identifying the leading modifiable risk factors, to developing better medications or procedures and advocating for healthy public policies. We’ve come such a long way, but we know our work is not done,” says Bobbe Wood, President, Heart and Stroke Foundation.
Heart Healthy Tips for All Canadians
Not all the factors that put Canadians at risk can be controlled but up to 80 per cent of heart disease and stroke is preventable. Healthy behaviours all Canadians can adopt to make health last include:
• Eat a healthy diet. Follow the recommendations in Canada’s Food Guide.
• Be physically active. 30 minutes most days of the week is all it takes to start, and everything counts.
• Be smoke-free.
• Manage stress. Identify the source of your stress, talk to friends and family, and take time for yourself.
• Limit alcohol consumption. Women should limit themselves to no more than two drinks a day, to a weekly maximum of 10; and men to three drinks a day, to a weekly maximum of 15.
The Heart and Stroke Foundation’s mission is to prevent disease, save lives and promote recovery. A volunteer-based health charity, we strive to tangibly improve the health of every Canadian family, every day. Healthy lives free of heart disease and stroke. Together we will make it happen. heartandstroke.ca