Although emergency treatment can save life after a heart attack, the effect can be so debilitating that a return to everyday life is hard to achieve.

And some victims need to be educated about healthy living to prevent another attack.

The British Heart Foundation's survey of 520 patients revealed the patchy nature of cardiac rehabilitation services across the country.

Sudden death

People living in the north-west and south-east had the best chance of being offered a programme of rehabilitation.

But in the Midlands and East Anglia, patients were the most unlikely to be offered the treatment.

The Chartered Society of Physiotherapy (CSP) immediately called on Health Secretary Frank Dobson to launch an official inquiry.

The society says exercise-based rehabilitation can reduce the rate of sudden death by a quarter.

CSP chief executive Phil Gray said: "The number of people missing out on cardiac rehabilitation is shocking and is a major failure of support for people who have had heart attacks.

"Rehabilitation is essential - a literal life saver - and not some kind of optional bolt-on extra."

He suggested the government's proposed Commission for Health Improvement - a quality watchdog for the NHS - would be the ideal mechanism for ensuring aftercare is available.

Katherine Peel, head of cardiac care at the BHF, said: "This research has clearly highlighted that heart patients are not getting the rehabilitation advice they need to help them return to a full and active life after heart surgery or heart attack."

Exercise and advice are vital

She called for a common standard of rehabilitation to be offered, including exercise and lifestyle education.

Heart attack victims can lead virtually normal lives

It also must include, she said, an assessment of personal risk factors for future illness, and help to address any psychological damage the disease has caused.

These standards are thought to be included in a National Service Framework on coronary heart disease which is due to be released by the government.

The framework will include minimum expected quality standards in coronary care, such as an eight-minute deadline to first treatment after dialling 999, and the guarantee of a specialist for patients with new or worsening angina.

The original date for the release of the framework was April 1999.