Are our patients getting the cardiac rehab they deserve?

1. Are our patients getting the cardiac rehab they deserve? Suzanne Indge CNS 2010

2. National Service Framework June 2009 • Standard 6 Providing cardiac rehabilitation Everyone with established coronary heart disease is offered an appropriate evidence-based cardiac rehabilitation plan and has the high quality, multi-disciplinary cardiac rehabilitation support they need to achieve this plan.

3. Gold Standard Cardiac Rehab? • If there is such a service what would it look like? • What do our patients want?

4. The Aneurin Bevan Experience • Funded in the North as suggested in the SIGN guidelines 2002. This includes 3 band 7s, 3 band 6s and full multidisciplinary teams caring for patients with Heart Failure, Angina, ACS and Pre/Post Surgery. Fully compliant with BACR Standards and Core Components for Cardiac Rehabilitation 2007. • Underfunded in the South • One Consultant Nurse who is responsible clinically, managerially and financially for the service across the LHB

5. The Abergavenny Experience - Inpatients • Patients have access to cardiac rehab nurse specialists for specific advice regarding their acute care, treatment and investigations, medication, risk factor management, reassurance for themselves and their families and discharge planning. The nurse specialists provide care for patients with Heart Failure, Angina, Acute Coronary Syndromes and Pre/Post Cardiac Surgery • When required patients are referred for specialist interventions with the cardiac rehab occupational therapist, physiotherapist or psychotherapist.

6. Post discharge • Patients have direct access to telephone advice from multidisciplinary team for symptom management and monitoring • Home/hospital visits are arranged if required • Liaison with GPs, practice nurses and other healthcare agencies • Early access to 8 week cardiac rehab programme if necessary • When required patients are referred for specialist interventions with the cardiac rehab occupational therapist, physiotherapist or psychotherapist. • Direct link via nurse specialists to Cardiology Consultant

7. 8 week Cardiac Rehab Programme • Twice weekly visits, for two hours, providing access to the comprehensive multi disciplinary team • Patients have access to physiotherapy, occupational therapy, dietetics, pharmacy, psychotherapy and sex therapy. • Patients physical and psychological well being is addressed • Education regarding risk factor management, medication, symptom recognition and treatment and lifestyle change • Cardiac Rehabilitation should be tailored to the patient irrespective of diagnosis to optimise adherence • Direct link via nurse specialists to Cardiology Consultant

8. Long term maintenance • Patients are encouraged to continue their lifestyle changes long term • 4 band 5 BACR fitness Instructors providing 22 community based maintenance classes in North Gwent area • Funded by North Gwent Cardiac Rehabilitation and Aftercare Charity • National Exercise Referral Scheme • Other local agencies i.e. Extend

9. Long term follow up • All patients are referred back to their GPs and practice nurses for long term monitoring of their risk factors • Complex patients remain with the nurse specialists for medication titration, symptom management and monitoring • Direct link via nurse specialists to Cardiology Consultant and other healthcare specialists i.e. lipid clinic, palliative care

10. Equality and Diversity • Literature provided in large print and on audio CD for visually impaired patients • Loop system used for education for hearing impaired patients • Interpreter service used for patients whose first language is not English • Multi lingual resources from British Heart Foundation • Staff trained in Equality and Diversity and disability awareness

11. Is this a “gold standard” service? • What about patients with arrythmias? • Are we capturing all our patient groups? • All goes well until staff go on leave, SIGN guidelines for staff ratios do not appear to allow for staff on leave • NLIAH Yellow Belt Training Cardiac Network

12. Team Developments • Team Building • Sharing Best Practice • Clinical Case Presentations • Patient Public Involvement – charities, focus groups, patients attend staff meetings regarding service redesign • Good support from Aneurin Bevan Executive Team

13. Where do we go from here as the All Wales C R Working Group? The Challenge • How can we achieve gold standard cardiac rehab with limited resources • Proving cardiac rehab can be cost efficient • Redesign • Sharing best practice • What can The AWCRWG do for you • What can you do for The AWCRWG

14. Where do we go from here as the All Wales C R Working Group? Influencing the future • British Heart Foundation Cardiac Rehab Campaign ensuring cardiac rehab is at the top of the WAG agenda • Audit vitally important – National Audit of Cardiac Rehabilitation, local audit. • Ensuring Cardiac Rehabilitation is high on the LHBs agenda and LDPs • Continue to work with partners Cardiac Networks, BHF, BACR, NERS • Develop Nursing sub group to address competencies and standards