Many hospitals in England are failing to offer heart attack patients the rehabilitation care they deserve, a medical charity report has warned.
Rehabilitation reduces the risk of death
The Coronary Prevention Group looked at 28 of the 260 centres that operate in England and found tremendous variability in service provision.
Areas of real concern were access, staffing shortages and underfunding, said the authors.
The government insisted it had made real improvements to heart services.
But Professor David Brodie, one of the report's authors, said: "Many people are reporting they have seen very little progress in recent years.
"The consequence of that, as we have shown, is that people are not getting the treatment they need.
"We have seen numerous situations where there are insufficient staff and physical resources to achieve basic levels of care.
"I do not think that if I had a heart attack I would accept it if a local cardiac rehabilitation unit has to close for four weeks simply because there is no staff.
"We have seen incidents of that sort happening."
The report concluded many centres were failing to meet the national standards set for coronary heart disease by government in 2000.
While most had met the government target of 85% of patients being offered rehabilitation after a heart attack or bypass surgery, none had figures to support the claim.
Only one had carried out a 12-month audit to follow up patients who had undergone rehabilitation to check that they were complying with lifestyle advice.
Just six of the centres met full-time staffing number quotas.
Although heart disease is Britain's biggest killer, cardiac rehabilitation can reduce the risk of death within three years by 20%, the researchers said.
About 160,000 people who survive a heart attack each year could be helped by such services, they said.
Roger Boyle, national director for Heart Disease, said: "We have transformed heart care services, bringing faster and better treatment and real improvements.
"There are more staff, there is more money, faster treatment, and better drugs.
"No-one waits more than six months for heart surgery compared to nearly 2,800 waiting over six months in March 2000.
"The death rate from circulatory disease has improved by 27.1% over the 1995-97 baseline."
He said initial work had concentrated on emergency care and hospital treatment, and that the focus was now shifting to prevention and rehabilitation.
Professor Peter Weissberg of the British Heart Foundation said although there were some excellent cardiac rehabilitation programmes, provision was patchy.
"That is why, with the help of a £4.7m award from the Big Lottery Fund, the BHF is currently developing 36 community-based cardiac rehabilitation programmes across England."