Cardiac Rehabilitation: Thinking Broadly

Professor Geoffrey Tofler19th September 2007

Background

• Rehabilitation - a key ingredient for optimal management of the patient with coronary disease and heart failure.

• Good hospital community linkage - goal of keeping patients well in the community.

• Standards of care - Disease Framework

• Models of care may differ

Stents as an Alternative to Lytic Therapy in Acute Myocardial Infarction

NSAHS primary angioplasty program

• Approximately 3,900 patients treated

• Average bed stay 3.2 days versus 7.2 days (lytic)

• Cost saving to NSAH $11,000,000 over 10 years.

• 200 patients “Field Triage” from 2004

• Mortality 2% at 30 days

Northern Sydney Cardiac Rehab and APAC Collaboration

• Provide seamless continuum of care - hospital to home

• Facilitate early and safe discharge from the acute setting

• Reduce anxiety levels

• Improve uptake to cardiac rehab program

• Access a wider population by introduction of an alternative home-based model

•(Helen Tsakonis, Ann Kirkness, Vanessa Baker)

ACS/PTCA AdmissionACS/PTCA Admission

Seen by CRSeen by CR

Referred to APACReferred to APAC

Seen at home within 24 hrs post dischargeSeen at home within 24 hrs post discharge

Cardiac CNSCardiac CNS PhysioPhysio OTOT S/WS/W PharmacistPharmacist

Cardiac RehabCardiac RehabGPGP CardiologistCardiologist

Results of Collaboration

• 85% of patients referred by CR seen by APAC (n=319)

• Positive trend in CR attendance (50 to 60%)

• Lowered anxiety levels

• Overall very positive feedback

IMAGE GOES HERE

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Ann Sullivan, Robyn Cleary, Geraldine Gillies,Susan Hales, Ingrid Pryde, Vanessa Baker

MACARF BREAKDOWN OF ENROLMENTS NOV 2004-OCT 2006

0

50

100

150

200

250

HOME P

ROGRAM

EDU

NSHNS

APAC

REFERRED CRHOS

NH OA

REHAB

NU

MB

ER

OF

PA

TIE

NT

S

2004-2005

2005-2006

NURSE INTERVENTIONS 2004-2006

28

15

38

44

20

3

5

41

54

17

25

100

37

50

79

25

0

10

57

34

37

27

0 20 40 60 80 100 120

OTHER PHONE CALL

SPECIALIST PHONE CALL

GP PHONE CALL

SERVICES

NSHNS

APAC

CARDIAC REHAB

HOME EXERCISE PROGRAM

OTHER MEDICATION ISSUES

CARDIAC MEDICATION ISSUES

EXTRA FRUSEMIDE

NUMBER OF INTERVENTIONS

2005-2006

2004-2005

Assuming addressing cardiac med issues and extra Lasix prevented an admission, 64 x 8 x $600 = $331,000 saved 2005/6

Use of Cardiac Rehab Facilities at Ryde Hospital – Kellie Roach

• Cardiac Rehab sessions, includes high risk diabetic patients – 2 sessions /week

• Heart Failure – 3 consecutive sessions (Susan Hales)

• Pulmonary Rehab – 2/week (Sally Watts)

• Joint replacement / orthopaedic (Steven Spinatti)

Collaborative Weight Management for Coronary & Type 2 Diabetics - Ann Kirkness

• 70% Cardiac Rehab patients are overweight or obese, and 68% remain so at completion.

• Obesity - risk factor for both CAD and Type 2 Diabetes

• CR and Diabetic Education Centre to share existing resources and more structured approach to weight.

• 33 patients since Sept 2006

• Mean 3.4kg weight loss at 4 months (33%≥5%)

• Increase physical activity (72%, 4month; 56%, 8month)

• Patient not service focussed

• Work together across different settings and disease stages

• Community colleagues

• Cardiac Rehab link with medical teams

• Involve other specialties

• Optimal use of resources

Summary