Heart attack survivors who participate in cardiac rehabilitation programs may survive longer, but feel no healthier, than they would without this follow-up care, a U.S. study suggests.

Previous research has linked medically supervised rehab programs focused on things like stress reduction, exercise and heart healthy living to lower mortality rates. The current study offered more evidence of this: rehab participants were 41 percent less likely to die of all causes during up to seven years of follow-up.

But in the first year after a heart attack, patients who went through cardiac rehab had health improvements similar to the group that didn't, the current study also found.

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"Despite no difference in health status noted in our study, patients who have suffered an acute myocardial infarction (heart attack) should continue to be referred and strongly encouraged to participate in comprehensive cardiac rehabilitation, given its association with increased survival," said lead study author Dr. Faraz Kureshi of the University of Missouri Kansas City School of Medicine.

Kureshi and colleagues examined data on 2,015 heart attack survivors who went through one of these programs and another similar group of 2,914 survivors who didn't.

At the start of the study, patients were 60 years old on average.

Compared with those who didn't participate in rehab, those who did were more likely to be male, white, married, employed full-time and have health insurance with coverage for medications, researchers report in JAMA Cardiology.

Patients who did cardiac rehab were also less likely to avoid seeking health care due to costs, have a history of prior heart attacks or a history of smoking. They were also healthier.

When patients were asked to rate their quality of life, treatment satisfaction and frequency of chest pain, there wasn't much difference between the group that did rehab and the group that didn't.

With rehab, however, patients did report a small but statistically meaningful difference in physical limitations.

The results underscore a lack of evidence to support the recommendation of cardiac rehab to help people feel healthier after a heart attack, the authors conclude.

Limitations of the study include the reliance on patients to accurately recall and report whether they participated in rehab and what improvements they may have experienced in health outcomes, the authors note.

It's possible, too, that it's a stretch to attribute longer survival times to cardiac rehab since people were counted as participants in this group if they did even a single session, Dr. Hani Jneid of Baylor College of Medicine in Houston wrote in an accompanying editorial.

Still these programs are safe and cost-effective and the study results suggest doctors could refer patients for rehab more often than they do now, Jneid wrote.

"Irrespective of the neutral effects on health status observed in the current report, the benefits of exercise-based cardiac rehab have been extensively demonstrated," Jneid said by email.

"Besides conditioning and increasing physical activity in a monitored and safe fashion, it has numerous direct health benefits," Jneid added. "These include weight reduction, and improvement in lipid levels, blood pressure, and other risk factors."