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Developing rehabilitation for people with heart failure

Developing rehabilitation for people with heart failure. Evolving services in Newcastle upon Tyne Christine Baker. In the beginning…. Increasing prevalence of heart failure People with heart failure are frequently admitted to hospital

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Developing rehabilitation for people with heart failure

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  1. Developing rehabilitation for people with heart failure Evolving services in Newcastle upon Tyne Christine Baker

  2. In the beginning…. • Increasing prevalence of heart failure • People with heart failure are frequently admitted to hospital • Heart failure is linked with poor prognosis and significant impact on everyday life. • Growing evidence base: • Exercise is safe and beneficial for people with heart failure • NSF for CHD lists cardiac rehabilitation, risk factor advice, physical activity and psychosocial interventions as key interventions for people with heart failure

  3. Figure 1 Hazard ratios and 95% confidence intervals for the individual studies for the effect of exercise training on risk of death . (ExTraMatch collaborative, BMJ, 2004)

  4. In Newcastle upon Tyne: • In 2003 there was no rehabilitation service for people with heart failure • A group was set up to address heart failure in the acute hospitals trust – supported piloting a specific programme • We had available resources within the acute Hospitals Trust • A rehabilitation facility • An experienced multi-disciplinary team

  5. RVI rehab team • Cardiac rehabilitation nurse • Physiotherapist and physiotherapy support • Occupational therapist • Pharmacist, cardiologist, psychologist, dietician providing flexible input • Administration support

  6. 1. Information needs Individually relevant information Facts about heart failure Coping with heart failure Lifestyle change Dealing with others Practical advice Process: involve family members written information group discussion (not talks) share information An evolving model – service user views

  7. 2. Physical activity • Goal – to increase stamina and improve tolerance for exercise so not so tired • Need for individualised exercise • Home exercise plan • Something to do daily • Group to provide support 3. Relaxation 4. Time for peer support

  8. Programme model • Condition (Heart failure) and evidence-based • To help participants develop knowledge, skills and confidence to improve and sustain achievable health and functional activity. • 16 weekly sessions (2 hours) • Up to 12 participants, partners invited • Collaborative: participants actively involved in planning programme, goal setting and monitoring progress

  9. Individual reviews • A facilitated, personally set home-based exercise programme, developed and practiced at rehab. • Activity plan and home diary to record and monitor activity • Relaxation approaches demonstrated • Programme of discussion topics

  10. Discussion topics • Understanding heart failure • Taking control of symptoms • Adjusting and coping • Managing at home • Medication • Approaches to food and eating • Exercise – what can I do • Social support and community resources

  11. Participants: recruitment and inclusion criteria • Potential participants identified by cardiologist or ward sister • NYHA class 2 or 3 • LV systolic dysfunction underlies heart failure • Stable for 4 weeks • Angina no worse than CCS 3, and been assessed • Reviewed in cardiology clinic • People with devices can be included

  12. Exclusion criteria • NYHA class 4 • Severe angina/ischemia • Uncontrolled heart failure, worsening symptoms • Change in treatment due to worsening condition • BP < 90 mmHg systolic, or < 100 if associated dizziness • Resting heart rate>100 beats/min • Uncontrolled arrhythmias • Febrile illness • Cardiologist considers unsuitable

  13. The participants 4 men, 3 women Aged 43 – 79 years Class 3-4: 4 – Left ventricular systolic dysfunction, 2 – cardiomyopathy Ejection fraction 20 – 72% Co-morbidity: History of CHD (5), renal impairment (3), asthma (2), diabetes(2), Hyperthyroidism (2), Obesity (3), Peripheral vascular disease(1) Attendance 2 did not engage in group 2 died in course of programme 3 regularly attended whole programme Family members attended Evaluation

  14. Relevant past medical history (NYHA class, cause of heart failure, ejection fraction, exercise tolerance test Medication Weight Orthopnoea (numbers of pillows to sleep) Nocturnal dyspnoea Leg fatigue Occupational therapy functional assessment Shuttle walk test Hospital Anxiety and Depression Scales Minnesota Living with Heart Failure Questionnaire Personal goals Any recent worsening of symptoms (ankle swelling, fatigue, dizziness, shortness of breath, sleep problems) Resting blood pressure, heart rate, SaO2, respiratory rate

  15. Goal achievement Common goals: • To improve confidence • To understand condition • To increase energy levels • To learn what I can do and how far to go • To take up a specific activity • To have a practical need met Participants reported a good degree of goal attainment

  16. Participant feedbackSemi-structured interview • Altogether positive • Constructive: • Programme offered at diagnosis • Opportunity to attend at intervals in future • Issue of prognosis, palliative care and deaths • Issue of maintenance • Issue of support for family members

  17. Staff feedback • Referrals –too few– Class 3 and 4: address referral • Collaborative approach -individual goal setting -home-based programme– worked well • Develop rolling programme and flexible intervals for participants – address maintenance/community links • Develop written information • Evaluation – Formal and sessional evaluation OK - capture self-efficacy • Confidence and experience of staff has developed

  18. Next steps • Further developing as a rolling programme • Cardiologists and BHF heart failure nurses involved in recruitment • Evolving links with community services re. maintenance • Continuing to evaluate

  19. Taking control of Heart FailureA community development project

  20. Taking control of Heart FailureA community development project • Based in inner west of Newcastle-upon Tyne • Supported by grant from Health Action Zone: partnership funding for preventative programmes • Partnership of community and health (PCT) providers

  21. Taking control of heart failureModel • Based on community development methods and principals. Innovation-based. • Objective: to empower people to take more control of their lives – to add value • Fundamentally a quality of life programme, not a disease based programme • Participants determine programme structure and outcome evaluation (no physiological measures)

  22. Taking control of heart failureProcess • 2 BHF funded HF nurses working with GPs and practice nurse IHD leads from 2 practices • 32 people with class 2 heart failure identified • Written invitation to participate – follow-up telephone call • BHF nurses visiting willing people at home to meet, provide information and discuss group. • Invitation to group.

  23. Taking control of Heart FailureProgramme • 2 closed groups • Ten weekly sessions • Facilitated by community development worker with experience in such projects and group facilitation • Content directed by group • Potential involvement of local cardiac rehab team – pharmacist, psychologist, exercise specialists, nutritionist

  24. Over to you…

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