The Integrated Croydon Cardiac Rehabilitation Team

Nurses - Sarah Hicks, Mary Stanley, Angela White, Elisabeth Visagie and Carmel Messenger Physiotherapist - Patryk Durnas Exercise Professional – Audrey Livingston Latha Sajjan – Clerical Officer

Cardiac Rehabilitation

……. an inexpensive treatment that saves lives, reduces disability, improves health related quality of life and helps people fight back against heart disease by becoming active self managers of their condition BHF 2008

The Evidence

Reduces Improves Supports • • • • • • • • All cause mortality by 11-26% Cardiac mortality by 26-36% Morbidity Unplanned admissions by 28-56% Heron et al 2011 Quality of Life Functional capacity Early return to work The development of self management skills

‘If there was a pill that cost very little, reduced cardiac deaths by 27% , improved quality of life, and reduced anxiety and depression, every cardiac patient in Europe would be expected to take it. There is no such pill but taking part in a Cardiac Rehabilitation Programme can provide all these benefits Prof Bob Lewin 2005

The Integrated Croydon Cardiac Rehabilitation Team

……. Our aim is to offer a clinically effective, cost effective service for patients where they feel safe and are able to learn in an environment that enables them to maintain healthy lifestyle changes

Current Inclusion Criteria

• STEMI/ NSTEMI (+/- Primary PCI, Heart Failure, PPM or ICD) • • • • • • Unstable Angina requiring PCI Stable Angina requiring PCI Post Coronary Artery Bypass Graft Post Valve or other Cardiac Surgery Patients post Heart Transplant (2) Patient with an LVAD (1) (there is no exclusion criteria for referral among these groups)

Referrals for 2013

Total = 907 patients

BACR Guidelines

Comprehensive Cardiac Rehabilitation Options

Exercise: Gym based classes Low, Moderate or High intensity 1:1 Exercise Home Based instruction with low intensity diary Early referral to Active Lifestyles Education: Classes currently in CUH but hope to other venues. Improved referral options to Psychotherapist, Weight Management and Smoking Cessation Services Relaxation: Relaxation techniques, Breathing exercises, Visualisation

NICE Guidelines 2013

• • • • • Offer a CCR programme that improves uptake within 10 days of discharge Offer advice re Mediterranean diet, smoking cessation and exercise Ensure appropriate drug therapy is prescribed and up-titrated Communication to you to include diagnosis and advice re secondary prevention Help ensure Echo’s are requested.

Future Local Guidelines

• • • • • • Identify and offer service early – all contacted in 4 days Central point of contact – already met See patients pre intervention Offer programmes in evenings and Saturdays Offer in Community settings – currently Active Lifestyles Offer separate programmes for HF and ICI patient once appropriate staffing levels agreed

Challenges

• • • • • • • Early discharge – no time for reflection of chronic disease Increase in co –morbidities since 13% (2006) to 46% (2012) – increases need for case management post assessment Reduce waiting times for CCR and assessments Finding appropriate centres at an acceptable cost for nursing and physiotherapy assessment FCT and exercise out of office hours To see patients earlier and offer exercise advice to more people Improve uptake of CCR Maintaining National Database for Cardiac Rehab

Uptake 2012-2013

60 50 40 30 20 10 0 GB London Aiming to achieve 65% in 2014?

CUH

Patient Satisfaction Jan – Mar 2014

Q14 Overall how would you rate the cardiac rehab you received?

90 80 70 60 50 40 30 20 10 0 no response excellent very good good fai r poor

Please call or FAX us on 0208 401 3217

Thank you