The Integrated Cardiac Rehabilitation Team

Report
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
•
•
•
•
All cause mortality by 11-26%
Cardiac mortality by 26-36%
Morbidity
Unplanned admissions by 28-56%
Heron et al 2011
Improves •
•
Supports •
•
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
No of responses
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

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