Cardiac Rehabilitation Provision in Rural Wales: Demonstrating the benefits of a Service

1. 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

2. Demographics: Ceredigion • Population- 78,000 • NHS Trust catchment of 120,000 • Geographical area of 696 square miles • 1 DGH in Aberystwyth

3. 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

4. The Beginning • Heart Manual • Angina Plan • Hospital Based Phase III - One class per week in Physiotherapy gym • No Phase IV Provision

5. Ceredigion and Mid Wales NHS Trust Ceredigion County Council University of Wales Aberystwyth CAVO Ceredigion Association of Voluntary Organisations Dyfed/Powys Health Promotion Unit Collaborative Bidding- Physical Activities Forum

6. 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

7. 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

8. 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

9. Project Structure • Three Key Organisations • Two Sister Schemes • Management Board • Operational Team • Research Evaluation

10. 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

11. Practicalities of the Project • Health Walks • Maintenance package • Partner/Spouse/friend welcomed • Numbers in accordance with Risk Stratification

12. 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

13. Measured Psychological Outcomes

14. Measured Physiological Outcomes

15. 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

16. Sustainability of Psychological Outcomes: 6 months follow up

17. Sustainability of Physiological Outcomes: 6 months follow up

18. Participants feedback: At 6 months assessment Main Reasons for not exercising: • ill health • time • lack of group support

19. 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

20. 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

21. Outcomes • Identified the importance of a local community-base 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

22. 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

23. 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

24. Patient Driven Reduce to three Centres Participant Payment Maintenance Classes Maintenance Booklets Obesity-Body fat analyzer Changes following Project End

25. 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

26. For more information contact mair.parry@ceredigion-tr.wales.nhs.uk Thank you for Listening