Transcript Slideshow (PowerPoint)

Cardiovascular Rehabilitation
and Secondary Prevention –
Why is it so important?
What is Cardiac/Cardiovascular Rehabilitation
(CR) and Secondary Prevention (SP)?
 “Cardiac Rehabilitation describes all measures used to help
people with heart disease return to an active and satisfying life
and to prevent the recurrence of cardiac events”
 “…..it involves medical care, control of biomedical and
behavioural risk factors, psychosocial care, education and
support for self-management”
I’m confused, is it Cardiovascular or Cardiac
Rehabilitation or Secondary Prevention?
 These are all similar terms which are often interchanged.
 Cardiac/Cardiovascular Rehabilitation is often time-limited, a
component of the Secondary Prevention continuum that is lifelong.
 Cardiovascular is often used instead of Cardiac as a more
encompassing term for Rehabilitation that is offered to people at
high risk of cardiovascular disease or who have peripheral
vascular disease.
It doesn’t matter so much what you call it
as long as the patient gets referred for it!
Evidence for Cardiac Rehabilitation and
Secondary Prevention
 Improves survival 1-4
 Improves: functional status, cardiovascular risk profile, quality
of life, resulting in fewer psychological disorders and
unplanned hospital readmissions 5-7
 and saves money 4,8
 People with peripheral arterial disease also benefit9
Important messages
 CR and SP is part of usual care
 It’s everyone's job to help ensure
that all patients have access to CR
and SP
 CR and SP is as important as
medications or surgery
 Must be flexible and accessible
What is the problem?
CR programs are effective if people attend…BUT participation
rates can be as low as 10 - 30%.
Recent evidence (SNAPSHOT study):
 27% acute coronary syndrome patients received optimal inhospital preventive care.
 ‘Optimal care’ means receiving lifestyle advice, referral to
rehabilitation and prescription of secondary prevention drugs.
 STEMI, NSTEMI, PCI/CABG during admission or history of
hypertension were more likely to receive optimal preventive
care.
 Older patients (>70yrs) or admitted to private hospital = less
likely to receive optimal care.
What policy do we
have?
 http://www.healthnetworks.heal
th.wa.gov.au/docs/1405_CRSP
_Pathway_Principles_WA.pdf
plus
 Quick Reference Guide and
Consumer information sheet
…insert link
CRSP Pathway
Principles
Part 1: Pathway overview
Part 2: More detail –
colours corresponding
to part 1
Who is eligible ?
As stated in the pathway….
 All inclusive
 Heart patients and those at risk
 Young and old
 Not just patients with Acute Coronary Syndrome
 For primary care and hospitals
● Needs Assessment, Education and Resources ●
Assessment on presentation by Nurse (Ward or Primary Care), Allied Health, Aboriginal
Health Professional, GP and/or Medical (team) to determine individual needs, assess
self-management capacity and commence education (Detail section 5a: additional
information)
 This is where education starts and resources are provided
 All health professionals have a role to play here
 Reinforcement by many members of health care team is
important
 Consider an assessment tool such as CRNAT
http://www.heartonline.org.au/SiteCollectionDocuments/Cardiac%20rehab%20needs%2
0assessment%20tool.pdf
▲Spectrum of Complexity ▲
AT RISK OF CARDIAC
CONDITION
(MOD TO HIGH ABSOLUTE
RISK)
LOWER COMPLEXITY
CARDIAC CONDITION OR
NEEDS
HIGHER COMPLEXITY
CARDIAC
CONDITION OR NEEDS
 To determine complexity, criteria suggested but not set in stone
 Position on spectrum helps determine the level of support needed
 Intensity and duration vary depending on:
 Needs (physical, medical, functional, cognitive, psychosocial)
 Preferences
 Available resources
♦ Referral ♦
Referral: by GP, Primary Care Nurse,
Aboriginal Health Professional to secondary
prevention service(s) most acceptable to
person
♦ Referral & Case management
♦ Health, Aboriginal
Referral: By Nurse, Allied
Health Professional or Medical team to
specialised cardiac rehabilitation service(s)
most acceptable to person
Case Management: By Cardiac
Rehabilitation Coordinator, Heart Failure
Nurse, telephone-based service provider or
other before discharge or within the week
after, to assess and plan early
commencement of rehabilitation
 Referral to the most appropriate and accessible service
 Periodic assessment and/or case management whilst encouraging self
management
 Variety of ways to receive education/support & encourage behaviour
change
 Commence CR early.
♥ Secondary Prevention &
Ongoing Care ♥
Education, Self Management & Behaviour
Change
Individual Consultation and/or Chronic Disease/
Secondary Prevention / Healthy Lifestyle Program.
By GP, Primary Care Nurse, Allied Health and/or
Aboriginal Health Professional
Exercise
Community based exercise program and/or
Individual exercise advice
Psychosocial Support
+ Peer support group
+ Individual consultation
By GP, Primary Care Nurse, Allied Health,
Aboriginal Health Professional and/or Psychologist.
Medical Follow-up
Regular GP visits
Specialist if required
♥ Cardiac Rehabilitation ♥
Education, Self Management & Behaviour
Change
Specialised group, individual and/or telephone
education.
(Detail section 5a: additional information)
Exercise
Specialised group and/or specialised individual
exercise advice
Hospital based if clinically indicated or at patient’s
request.
Psychosocial Support
+ Group Education Sessions (and/or peer support)
+ Individual Consultation (face to face or telephone)
By Case Manager, Allied Health and/or Psychologist.
Medical Follow-up
Cardiology follow-up appointment post discharge
& Ongoing Care
Case study 1: Jack 74 year old from
Midland, presents to tertiary hospital
cardiology out-patient clinic for cardiology
follow-up. Non STEMI 6/12 ago, presents
to clinic in Heart Failure.
Registrar assesses patient, determines
complex education needs and refers to
Heart Failure Nurse
Heart Failure Nurse visits Jack in outpatient clinic. Commences education and
arranges to follow-up via telephone
Heart Failure Nurse:
1. Provides telephone follow-up
2. Supports titration of medications
3. Liaises with GP
4. Refers to physio for exercise
5. Once stable refers to chronic disease
self management program
©2014 National Heart Foundation of Australia
Case Study 2: 48 year old Aboriginal
gentleman from Bayswater admitted to
Tertiary Hospital following STEMI,
underwent PCI
Assessed on ward by nursing staff,
education commenced and referred to
CR coordinator. Some anxiety and
concerns re returning to work. Higher
complexity needs detrmined.
CR coordinator phones patient at home 3
days after discharge and assesses
progress. Refers patient to DYHS heart
health program
Cardiac Rehab coordinator at DYHS
contacts patient and enrolls him into the
program for education, exercise and
support.
Cardiology outpatient appointment and
GP follow-up, including liaison with
DYHS CR Coordinator.
©2014 National Heart Foundation of Australia
Case Study 3: Sam 52 year old presents
to GP. Is a smoker, overweight, has
hypercholesterolemia and high absolute
risk.
GP assesses patient, determines at risk
of cardiac condition with education needs
and refers to practice nurse for follow-up
Practice Nurse and GP:
1. Ongoing support and education and
assessment of risk factors
2. Referral to dietitian and QUIT
program
3. Referral to healthy lifestyle program
©2014 National Heart Foundation of Australia
Case Study 4: Mr X, 65 year old
presents to GP. Hx: STEMI 3 months
ago, expressing fear of having another
heart attack, showing signs of depression
and anxiety.
GP assesses patient, determines that he
has require some support.
Commences mental health care plan,
refers to Clinical psychologist and refer to
CR program for exercise.
Practice Nurse and GP:
1. Ongoing support and education and
assessment of risk factors
2. Follow-up with clinical psychologist
3. Specialised CR exercise program
©2014 National Heart Foundation of Australia
Case Study 5: Mrs Y, 44 year old
presents to GP. Recently discharged from
hospital following admission with
NSTEMI. Patient refused CR referral, has
multiple risk factors and reluctant to take
medications.
GP assesses patient, and explains
options for support and lifestyle
modification. Patient chooses services
most suitable
©2014 National Heart Foundation of Australia
Case Study 6: Simon 67 year old man
with history of STEMI (2010) presents to
GP for routine check. Has stopped taking
meds, over-weight and some recurrent
angina. No S/L nitrates or knowledge of
angina Mx
GP assesses patient, determines lower
complexity cardiac condition and refers
to:
 Practice Nurse
 Cardiac Rehabilitation Coordinator
 Cardiologist for review
Practice Nurse and GP:
1. Ongoing support and education
2. Referral to Community exercise
program
Cardiac Rehabilitation coordinator enrolls
patient into cardiac rehabilitation
education sessions and liaises with
practice nurse re progress.
©2014 National Heart Foundation of Australia
What resources are available?
What’s the Heart Foundation role in
improving Cardiac Rehabilitation in
Australia?
http://www.heartonline.org.au
http://www.heartfoundation.org.au/information-for-professionals/Clinical-Information/Cardiacrehabilitation/Pages/default.aspx
Important messages
 CR and SP is part of usual
care
 It’s everyone's job to help
ensure that all patients have
access to CR and SP
 CR and SP is as important as
medications or surgery
 Must be flexible and
accessible
Thankyou
If you have feedback or any concerns, about the content of
this presentation or supporting materials please email the
Cardiovascular Health Network on
[email protected]