Transcript Cardiac Rehabilitation Provision in Rural Wales

Cardiac Rehabilitation Provision
in Rural Wales: Demonstrating
the benefits of a Service
Gwenllian Parry
Community Cardiac Rehabilitation
Specialist Nurse
Ceredigion and Mid Wales NHS Trust
Demographics:
Ceredigion
• Population78,000
• NHS Trust
catchment of
120,000
• Geographical
area of 696
square miles
• 1 DGH in
Aberystwyth
Project Team
• Denise Lewis- Cardiac Rehabilitation Coordinator,
Ceredigion and Mid Wales NHS Trust
• Gwenllian Parry- Cardiac Rehabilitation Specialist
Nurse, Ceredigion and Mid Wales NHS Trust
• Justyn Robbins- Specialist Fitness Instructor
Ceredigion and Mid Wales NHS Trust
• Rachel Rahman- Research Assistant University of
Wales Aberystwyth
• Professor Jonathon Doust- Head of Chelsea School
University of Brighton
The Beginning
• Heart Manual
• Angina Plan
• Hospital Based Phase III - One class per week in
Physiotherapy gym
• No Phase IV Provision
Collaborative Bidding- Physical
Activities Forum
• Ceredigion and Mid
Wales NHS Trust
• Ceredigion County
Council
• University of Wales
Aberystwyth
• CAVO Ceredigion
Association of
Voluntary
Organisations
• Dyfed/Powys Health
Promotion Unit
Result
• Big Lottery Fund Grant £289.000 over 2½ years
• Working in Partnership with our Sister project
“Ceredigion Exercise For Life Scheme”
• Research Assistant Commissioned
Aims of the Project
• Reduce inequalities for Cardiac Patients within
Ceredigion.
• Improve quality of life for Cardiac Patients and
their families in and around the county.
• Promote social integration
• Promote long term adherence to a healthy lifestyle
Aims of the Project
• Provide a non institutionalised approach to health
promotion.
• To be inclusive for those who have acute or
chronic cardiac disease, and their families
• To provide a Cardiac Rehabilitation Specialist
Service that is accessible for all residents of
Ceredigion
Project Structure
• Three Key Organisations
• Two Sister Schemes
• Management Board
• Operational Team
• Research Evaluation
Practicalities of the Project
• 3 Cardiac Rehabilitation Staff - Nurse /Exercise
Instructor/Administrative Assistant
• Free Leisure Centre Based classes Gym and
Circuit
( twice weekly X12 weeks)
• Education and Relaxation Sessions
Practicalities of the Project
• Health Walks
• Maintenance package
• Partner/Spouse/friend welcomed
• Numbers in accordance with Risk Stratification
Data and Results
• 577 participants referred in 30 months
• 71% referrals commenced classes
• 69% of those completed classes
• 80% (209) of those completing the program
agreed to participate in the research
Measured Psychological
Outcomes
Measure
Change pre
to post
scheme
Desired direction
for change for
improved Health
Health Related Qol (Euro Qol)


Self-rated health (EQ VAS)


SF-36V2 Physical component summary


SF-36V2 mental component summary


Anxiety


Depression


Life satisfaction


Physical self-worth


Global self-worth


Habitual physical activity


Measured Physiological
Outcomes
Measure
Change pre to
post scheme
Desired direction
for change for
improved health
Hip Circumference


Waist Circumference


Weight


Skin fold measurements


Resting heart rate


Resting blood pressure


Heart rate post exercise


Blood pressure post exercise


Treadmill test time


Adherence at 6 months
follow up
• 136 randomly invited to 6 month follow up
• 86 (63%) responded to follow up questionnaires
• 71 participants were still exercising
• 15 reported they were not exercise
Sustainability of Psychological
Outcomes: 6 months follow up
Measure
Change from pre
to post scheme
Change from
pre scheme to
6 months
Health related QoL (EuroQol)


Self-rated health (EQ-VAS)


SF-36V2 Physical component summary


SF-36V2 Mental component summary


Anxiety


Depression


Life Satisfaction


Physical self-worth


Global self-worth


Habitual physical activity


Sustainability of Physiological
Outcomes: 6 months follow up
Measure
Change from pre
Change from pre
to post scheme scheme to 6 months
Hip circumference


Waist circumference


Weight


Skin fold measurements


Resting heart rate


Resting blood pressure


Heart rate post exercise


Blood pressure post exercise


Fitness test duration


Participants feedback:
At 6 months assessment
Main Reasons for not exercising:
•
ill health
•
time
•
lack of group support
Participants feedback at
6 months
Changes suggested by patients to help
maintain exercise:
• Regular check ups on progress
• Maintenance classes
• More help from staff during transition from group
to individual session.
• Take home safety tips common problems, exercise
tips and guidance.
• Taster sessions for other activities
Outcomes
• Statistically significant physical and psychological
Improvements during the period of the scheme
• Provided Phase IV provision where none existed
in Ceredigion
• Demonstrated need by recruiting 577 participants
in 2½ years
Outcomes
• Identified the importance of a local communitybase and an emphasis on patient confidence and
independence in achieving high participation and
low attrition
• Demonstrated a sustained impact at 6-month
follow-up once participants had left the scheme
• Demonstrated significant improvements in
physical and psychological health
Cost Analysis
• The scheme cost £722 per participant
• (NICE) National Institute of Clinical Excellence
judges effective treatment as costing less than
£20,000 per quality adjusted life year
• The cost of the scheme was £8,112 per quality
adjusted life year, well within guidance issued by
NICE
Discussion
• Provision in a rural area needs to be patient and
not condition driven
• Importance of an inclusive service for all those
with cardiac related disease
• Does a Cardiac Rehabilitation service need to
have a huge multi-disciplinary team to achieve
standards and significant outcomes? This is as
stated in the recently released NSF and BACR
recommendations
Changes following Project End
• Patient Driven
• Maintenance Classes
• Reduce to three
Centres
• Maintenance Booklets
• Participant Payment
• Obesity-Body fat
analyzer
What Now?
• Continued funding for our community based
service for those in and around Ceredigion
• National CCAD database
• Measure benefits of continued inclusion of those
with controlled arrhythmias into the service
• Continue to Improve cross boundary
communications
For more information contact
[email protected]
Thank you for Listening