The odds are great that you or someone you care about will have a heart attack and survive it. But until I had a heart attack I was totally unaware that after surviving one there is a critically important option that far too few survivors take advantage of. It is called cardiac rehab, a medically supervised and monitored program of exercise with counseling, dietary and other features.

After a seven-day hospital stay where I received angioplasty, three stents and a pacemaker, my cardiologist informed me about the cardiac rehab program at the hospital. It sounded terrific and I did not hesitate entering the program. I had to wait awhile while I recuperated and then I had to pass a stress test to qualify for the program. But as soon I could, I entered the award-winning program at Suburban Hospital in Bethesda, Maryland.

An individualized, tailored program based on my medical condition was designed and over time the program evolves to restore physical strength and endurance through use of a variety of exercise machines. Rehab programs also provide referring physicians with valuable surveillance information on how well their patients are doing, information that may cause new decisions on medical treatment or drug intervention.

As I learned more about cardiac rehab I was shocked to learn that about two thirds of patients in the United States who survive a heart attack do not undergo outpatient cardiac rehabilitation, even though such programs have been proven to reduce the risk of illness and death, and to also improve psychological recovery, according to findings reported by the Centers for Disease Control and Prevention in Atlanta.

"Programs and policies directed at increasing the number of patients who are referred to and participate in cardiac rehabilitation need to be strengthened," CDC researchers reported in a recent issue of the Morbidity and Mortality Weekly Report. "Future research should focus on identifying barriers to cardiac rehabilitation participation and interventions to improve referral and receipt of outpatient rehabilitation services," they added.

To estimate the use of outpatient cardiac rehabilitation services among heart attack survivors, the CDC investigators analyzed data from a 2005 survey where 129,416 individuals responded to questions relating to heart attack and the use of cardiac rehabilitation. Amazingly, just 34.7 percent of heart attack survivors participated in outpatient cardiac rehab, which usually includes a number of interventions to address modifiable cardiac risk factors, as well as psychosocial counseling. The District of Columbia had the lowest usage rate at 22.6 percent, while Nebraska had the highest rate at 59.1 percent.

Note that cardiac rehab is covered by Medicare and I suspect many other forms of health insurance, because its benefits are so certain.

In the CDC study, patients who were more likely to participate in rehabilitation included men, those older than 49 years, Hispanics, married patients, college educated individuals, those with annual incomes of $15,000 or higher, and patients who lived in the middle of a metropolitan area. Employment status and health insurance coverage had no statistically significant effect on whether patients attended rehab.