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BACPR Annual Conference 2016 in collaboration with the All Wales Cardiac Rehabilitation and Heart Failure Working Group

Applying Evidence to PracticeCardiff Hilton, 6th and 7th October 2016

BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION AND REHABILITATION

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2 BACPR Annual Conference 2016

Welcome to BACPR 2016Dear Colleagues

On behalf of the BACPR conference committee I’d like to thank you all for joining us in Cardiff for this year’s annual conference, which we are delighted to be hosting in collaboration with the All Wales Cardiac Rehabilitation and Heart Failure Working Group.

We hope you enjoy the programme, which we have aimed to make as varied as possible, including speakers from all four UK nations, yet retaining a prominent Welsh presence. Our ‘Applying Evidence to Practice’ theme came from 2015 delegate feedback which asked for speakers to directly link their work to clinical practice. There was also a request for more time to ask questions, which we have endeavoured to accommodate. I think we all enjoy the enthusiastic discussions that follow each presentation. Aside from the main programme, we have our usual lunchtime symposia (this year sponsored by Astra Zeneca and MSD) and workshops (on NACR, prescribing and relaxation/CBT). Lunch bags will be provided this year to help you get to your chosen session quickly and enable you to participate fully without balancing a dinner plate! Please also take the time to visit the posters and stands in the exhibitor area, and our moderated poster session in the Thursday afternoon break. Our ‘country update stations’ from 2015 will return in a new and improved format. Aside from sharing exciting new projects and developments within each country, this stand will also offer the potential to win a prize, so is definitely worth a visit.

As always, you are invited to enjoy a drink whilst attending the BACPR’s AGM in the main conference hall at the end of Thursday’s session. At our prize giving on Thursday evening, we look forward to presenting awards to the ‘best moderated poster’ and to our ‘new investigator in scientific research’. Our ‘best oral abstract’ award will be presented after the healthy break on Friday morning. Details of all of the abstracts accepted for this year’s conference will be available on the BACPR Research Network which goes live just after conference opening at www.bacpr.com. This exciting new development within our website will allow us to share details of cardiovascular evaluative projects and research. Watch out for details during conference...!

Many thanks to all of our exhibitors and sponsors – particularly our senior partner, Astra Zeneca. And finally, huge thanks from myself to our conference team - Sally Hinton, Allison Atrey, Jacqueline Cliff, Sarah Quinlan, Vivienne Stockley, Valerie Collins and Lorna MacSween – all of whom have worked extremely hard all year in preparing this conference. We hope you enjoy!

Dr Aynsley Cowie BACPR Scientific Chair


I am delighted to welcome you to Cardiff for our 2016 annual conference, with the theme “Applying Evidence to Practice”. We are delighted to welcome the many illustrious speakers that Aynsley and her team have engaged and I think you’ll agree that the programme is varied, ambitious and exciting. In the 12 months since we last met in Manchester an awful lot has happened, much of which not even Mystic Meg would have predicted. An exit from the EU, a change in Prime Minister, a change in England football manager and a Welsh football team in the top 10 of world footballing nations! There is also a definite sea change in health policy occurring across the British Isles with the realisation that a focus on prevention (both primary and secondary) and patient/public health education (in order to facilitate self management) is critical to the delivery of an affordable NHS. Those of us at this conference and our many colleagues holding the fort back at home will be the key individuals that shape these policies and deliver future services. The annual conference is our opportunity to show case all that we do and demonstrate our infectious enthusiasm for prevention and rehabilitation medicine. Without doubt it is the highlight of the year for me (both professionally and, dare I say, socially!) and just like a fine wine, it does seem to get better with every passing year.

In addition to thanking all of the invited speakers for their contribution to our conference, we extend thanks to the people who have submitted abstracts for inclusion in the programme. We hope that you will consider submitting your research or programme innovation to us next year, as these abstracts really do show us where we could improve our own practice. Finally, we thank our sponsors, particularly our Senior Partner - Astra Zeneca, as without their support this conference would not be able to take place.

I do hope that your conference experience this year is enlightening and entertaining, and that you are energised to take new ideas and new connections back to your work-place. Thank you for supporting this year’s BACPR conference and have a great couple of days in Cardiff.

Dr Joe Mills BACPR President

Applying Evidence to Practice 3

ProgrammeThursday 4 - 5Friday 5 - 6

Exhibitors 7 - 9

Main Conference Sessions SpeakersDr Joe Mills / Jane Brooks 10Dr Jacky Austin 11 Professor Huon Gray 12Dr Nicola Guess 13Michele Gray 14Dr Patrick Donnolly 15Frances Divers 16Dr Will Man / Prof Rod Taylor 17 - 18Professor Sanjay Sharma 19Professor Patrick Doherty / Dr Ahmad Salman 21Professor Nick Oseei-Gerning 22Alex Gigg / Maria Davies 23 - 23Dr Mike Knapton 24Dr Michael Thomas 25Dr James Barry / Rachel Owen 26

Parallel Sessions SpeakersNursing / Psychology sessionsDr Janet McKay 27BACPR Exercise Professionals Group / Dietetics sessionsProfessor John Buckley 28Lunchtime Workshops 29 - 30Chairpersons 31 - 36Oral Abstract Presentations 37 - 42Moderated Posters 43Thursday Posters 44 - 45Friday Posters 46 - 47Research Network 48Global Survey 49Notes 50Diary Dates 51

Contents


THURSDAY 6th OCTOBER 2016

Registration opens from 9.30am

10.00-11.00 Pre-conference Workshop (all delegates welcome):Meeting BACPR/NACR Certification Standards [Ballroom]

11.00-11.30 Tea, Coffee, Stands, Posters and Country Update Stations [Exhibitor Area]

Session 1: Opening Address

11.30-11.35 Welcome and Housekeeping Dr Aynsley Cowie BACPR Scientific Officer

11.35-11.45 Conference Opening Address Dr Joe Mills BACPR President

11.45-11.50 Welcome from the All Wales Cardiac Rehabilitation and Heart Failure Working Group

Jane Brooks Heart Failure Nurse, Aneurin Bevan Health Board, Wales & Group Chair

Session 2: Chairs: Aynsley Cowie, Joe Mills

11.50-12.25 Game Changing - Using Research in Clinical Practice to Improve Patient Care

Dr Jacky Austin MBE Retired Nurse Consultant, Aneurin Bevan Health Board, Wales

12.25-13.00 An Overview of National CVD Priorities Prof Huon Gray National Clinical Director (Cardiac), NHS England

13.00-14.00 LunchSponsored Symposium by MSD [Ballroom]Prescribing Workshop: ‘Medicines Management - Achieving your 5 a Day (Heart Medications) Post-MI’ [Sophia]Stands, Posters & Country Update Stations [Exhibitor Area]

Session 3: Chairs: Katherine Paterson, Jo Hayward

14.00-14.30 New Developments in Dietary Management of Diabetes

Dr Nicola Guess Senior Lecturer, Kings College, London

14.30-15.00 Psychology in Health Behaviour Change and Weight Management

Michele Gray Specialist Health Psychologist, ABMU Health Board, Wales

15.00-15.45 Healthy BreakStands, Posters & Country Update Stations [Exhibitor Area]

15.00-15.30 Moderated Posters

Session 4: Chairs: Louise Jopling, Bernie Downie

15.45-16.15 The Emerging Role of Cardiac CT for Risk Stratification and Prevention

Dr Patrick Donnelly Consultant Cardiologist, South Eastern Trust, Belfast Queens University

16.15-16.45 The Scottish Government Modernisation Agenda for Cardiac Rehabilitation

Frances Divers Nurse Consultant, NHS Lothian & Scottish Government Clinical Champion for Cardiac Rehabilitatio

Session 5: The Great Debate Chairs: Gordon McGregor, Sarah Quinlan

16.45-17.30 Generic versus Specialist Rehabilitation ‘For’: Dr Will Man Consultant Chest Physician, Royal Brompton and Harefield NHS Trust & Senior Lecturer, Imperial College, London‘Against’: Prof Rod Taylor Professor of Health Services Research, University of Exeter

17.30-18.00 BACPR AGM (members only)


THURSDAY 6th OCTOBER 2016 EVENING EVENTS [Ballroom]

19.30 Drinks Reception

20.00 Gala Dinner and Prizes

22.00 Disco

FRIDAY 7th OCTOBER 2016

7.00 Early Morning Walk / Run

From 8.30 Registration Opens (day delegates only)

Parallel Sessions

BACPR Nurses Forum / PsychologyChair: Jacqueline Cliff

BACPR EPG / Dietetics Session Chair: Brian Begg

8.55-9.00 Welcome to Friday & Housekeeping

Session 6: Oral Abstract Presentations [Friary]

Session 7: Oral Abstract Presentations [Castle]

9.00-9.10 D Thompson Measurement of Medication Adherence Patterns Using an Ingestible Sensor in Patients Attending a Cardiovascular Prevention and Rehabilitation Programme

A Welsh Safety and Feasibility of High-intensity Interval Training in UK Standard Phase III Cardiovascular Rehabilitation

9.10-9.20 F Dalal After a Heart Attack: The Role of Primary Care

R Tipson Hosting a Specialist Weight Management Service in a Cardiovascular Rehabilitation Setting: Another Useful Step Towards ‘Generic’ Rehabilitation?

9.20-9.30 Z Hutchinson Meaning-centred Psychotherapy for Physically Ill Patients: Overview, and a Case Study within a Cardiovascular Community Service

S Ellis Improvements in the Mediterranean Diet Score and Fruit, Vegetable and Fish Consumption in a Diverse Ethnic Group Attending the Imperial Cardiovascular Health Programme

9.30-9.45 Questions to all presenters

Session 8: Generic Rehabilitation in Practice

Session 9:Diabetes and Exercise

9.45-10.15 The Ayrshire HARP Dr Janet McKay, Consultant Nurse, NHS Ayrshire & Arran

Position Statement on Exercise Considerations for the Cardiac Rehab Participant with Diabetes Prof. John Buckley, Professor of Applied Exercise Science, University Centre Shrewsbury

10.15-10.45 Healthy BreakStands, Posters & Country Update Stations [Exhibitor Area]

Session 10: Chairs: Sally Hinton, Dr Hayes Dalal

10.45-10.50 Award for Best Oral Abstract Dr Joe Mills BACPR President

10.50-11.30 Keynote: Assessing and Managing the Health of the Young Athletic Heart Predisposed to Myo-neural Dysfunction

Prof Sanjay Sharma Professor of Cardiology, St George’s University of London; Consultant Cardiologist; Director of London Marathon

11.30-12.00 NACR: To what extent does cardiac rehabilitation meet national minimum standards for service delivery?

Prof Patrick Doherty (BHF Research Group, University of York) and Dr Ahmad Salman (PhD student).

12.00-12.30 Save your Sex life, Save your Heart Professor Nick Ossei-Gerning Cardiologist , University Hospital of Wales


12.45-13.45 LunchSponsored Symposium by Astra Zeneca ‘Right care, right treatment post MI’ · The long term risk for patients post MI, Dr Joe Mills · Medicines optimisation post MI, Dr Rani Khatib · The ‘One Heart’ patient support programme – Hetty McConnon · Questions & AnswersOccupational Therapy Workshop: Relaxation / CBT [Sophia]Stands, Posters & Country Update Stations [Exhibitor Area]

Session 11: Chairs: Annie Holden, Alison Iliff

13.45-14.05 The Role of the Occupational Therapist in Cardiac Rehabilitation

Alex Gigg & Maria Davies Occupational Therapists, Cwm Taf University Health Board & Aneurin Bevan Health Board

14.05-14.35 BHF – Research Into Practice Dr Mike Knapton Associate Medical Director, British Heart Foundation

14.35-15.05 The Public Health Wales Strategic Plan: Supporting Cardiovascular Disease Prevention

Dr Michael Thomas Public Health Director, Public Health Wales

15.05-15.35 Cardiac Prevention and Rehabilitation – The State of the Nation

Dr James Barry Cardiologist / Electrophysiologist, Clinical Lead South Wales Cardiac NetworkRachel Owen Lead Cardiovascular Nurse, South Wales Cardiac Network

15.35-15.45 Closing Remarks and Evaluation, Dr Joe Mills/ Dr Alison AtreyFollowed by tea and networking


AstraZeneca

AstraZeneca is a global, innovation-driven biopharmaceutical business that focuses on the discovery, development and commercialisation of prescription medicines, primarily for the treatment of cardiovascular, metabolic, respiratory, inflammation, autoimmune, oncology, infection and neuroscience diseases. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. www.astrazeneca.com

Amgen

Amgen is one of the world’s leading biotechnology companies. Amgen is a values-based company, deeply rooted in science and innovation to transform new ideas and discoveries into medicines for patients with serious illnesses. www.amgen.co.uk

Arrhythmia Alliance

Arrhythmia Alliance is a coalition of charities, professional medical organisations and industry groups that works to promote the timely diagnosis and effective management of arrhythmias. By raising awareness and campaigning for the improved detection and care of heart rhythm disorders, Arrhythmia Alliance aims to extend and improve the lives of the millions around the world that these conditions effect. www.heartrhythmcharity.org.uk

British Heart Foundation

We are the nation’s heart charity and the largest independent funder of cardiovascular research. Coronary heart disease is the UK’s single biggest killer but we are leading the fight against it. Our pioneering research has been key in developing our best practice programmes that have helped transform the care of people living with heart and circulatory conditions. www.bhf.org.uk

Daiichi Sankyo

Daiichi Sankyo Group is dedicated to the creation and supply of innovative pharmaceutical products to address the diversified, unmet medical needs of patients in both mature and emerging markets. While maintaining its portfolio of marketed pharmaceuticals, the Group has also launched treatments for thrombotic disorders and is building new product franchises. www.daiichi-sankyo.co.uk

Human Kinetics

At Human Kinetics, our mission is to produce innovative, informative products in all areas of physical activity that help people worldwide lead healthier, more active lives. We are committed to providing quality informational and educational products in physical activity and health fields that meet the needs of our customers. www.humankinetics.com

BACPR would like to thank the following exhibitors for their valued support


Imperial College

This programme in Preventive Cardiology is delivered by an interdisciplinary team of academic staff from the National Heart and Lung Institute, together with senior clinicians from Imperial College Healthcare NHS Trust and visiting experts in the field of cardiovascular prevention and rehabilitation. This programme is aimed at healthcare professionals with a role in prevention of cardiovascular disease. www.imperial.ac.uk/medicine/study/postgraduate/masters-programmes/msc-pg-dip-and-pg-cert-preventive-cardiology/

LINC Medical

LINC Medical is an established important supplier of medical equipment and devices to UK healthcare providers and operates nationwide. The Company’s mission is to provide excellent customer support and offer cost effective products that enhance the patients’ and medical professionals’ quality of life and working environment. www.linc-medical.co.uk

MSD

Today’s MSD is a global healthcare leader working to help the world be well. MSD is a trade name of Merck & Co., Inc., with headquarters in Kenilworth, NJ, USA. Through our prescription medicines, biologic therapies and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programmes and partnerships. www.msd-uk.com

Nihon Kohden

Nihon Kohden are a well-respected Japanese company who design and produce high quality, innovative patient monitoring solutions. We will be showing our unique mobile monitoring devices which are particular suitable for cardiac rehab www.nihonkohden.net

The Dairy Council

The Dairy Council is a non-profit making organisation with a remit to present evidence-based information on milk, dairy productions, nutrition and health to a range of stakeholders including healthcare professionals, consumers, researchers, the food industry and media. The Dairy Council is staffed by registered dietitians and registered nutritionists. All consumer nutrition materials have received Information Standard certification from the Royal Society of Public Health and our workplace presentations for healthcare professionals have been endorsed by the British Dietetic Association. www.milk.co.uk

The Heart Manual Service

The Heart Manual Programme, NHS Lothian, is the UKs’ leading home based supported self-management resource for individuals with CHD. Used UK wide and further afield, it is supported by a wealth of evidence including 3 RCTs and is specified in NICE as a comprehensive programme validated for patients who have had MI/revascularisation. Book or digital formats are available. The NEW Cancer Manual-‘So what do I do now?’ is the result of a collaborative project and has been welcomed by many working in this area of healthcare. Please visit our stand at BACPR to find out more www.theheartmanual.com


University of Chester

Enthusiastic and responsive, the University of Chester is committed to providing the very best in teaching, learning, research, student support and partnerships. www.chester.ac.uk/postgraduate/cvr

University Hospitals Leicester NHS Trust

ACTIVATE YOUR HEART is an online cardiac rehabilitation programme that has been designed by cardiac rehabilitation specialists and patients at the University Hospitals of Leicester NHS Trust. The aim of the programme is to help people with coronary heart disease to manage their condition more effectively. It provides

advice and support for individuals to make lifestyle changes and reduce their risk factors for coronary heart disease. Progress is monitored throughout by a cardiac rehabilitation specialist. ACTIVATE YOUR HEART is password-protected and only those registered can access the programme. Devi, R et al (2014) Exploring the experience of using a web-based cardiac rehabilitation programme in a primary care angina population: a qualitative study International Journal of Therapy and Rehabilitation, September 2014, Vol 21, No 9Brough, C et al (2014). Increasing choice for cardiac rehabilitation patients: Activate your Heart- an interactive web-based programme. Journal of Medical internet Research June 2014, 16 (10) e242.

www.activateyourheart.org.uk/


Main Conference Sessions Speakers Session 1; Thursday 11.35 – 11.50

Dr Joe Mills Conference Opening Address

I graduated from Cambridge University with a First Class honours degree in Medicine/Economics in 1992, completed medical training in Cambridge & East Anglia in 1994 and was a British Heart Foundation junior research fellow from 1998 to 2001. I have been a consultant cardiologist at Liverpool Heart & Chest Hospital NHS FT since February 2007. My professional interests include cardiovascular rehabilitation (and it’s promotion), PCI (I am one of ten consultants providing acute/emergency interventions for acute coronary syndrome patients), transcatheter aortic valve implantation, and developing community CVD services – for which I am the clinical lead. I am ALS medical director for my Trust, cardiac lead for the Cheshire & Merseyside Strategic Clinical Network. I am current president of BACPR and relishing the challenges and opportunities that this responsibility affords.

Jane Brooks Welcome from the All Wales Cardiac Rehabilitation and Heart failure Working Group

Jane Brooks RGN, MSc Nursing, IP, BSc Systemic Counselling

Jane is a Heart Failure Specialist Nurse with over 12 years experience of working with heart failure patients in acute and non acute settings. In collaboration with the patient, family members and the wider multidisciplinary team, support is provided from the point of diagnosis through to end of life.

Jane has an interest in the provision of Cardiac Rehabilitation for Heart Failure Patients and currently facilitates a twice weekly hospital/community programme for Heart Failure Patients in North Gwent. She is also the current Chair of the All Wales Cardiac Rehabilitation & Heart Failure Working Group.



Dr Jacky Austin MBE Game Changing – Using Research in Clinical Practice to Improve Patient Care

Jackie’s post doctoral programme of research is varied and has been undertaken whilst carrying a clinical case load and operationally managing Cardiac Rehabilitation and Heart Failure Services.

To improve access to accredited heart failure education for nurses working in Wales, she instigated a nursing module ‘Caring for Patients with Heart Failure’ in partnership with the University of South Wales for which she is a Visiting Fellow.

Jackie was on the faculty of the Wales ‘Save a 1000 Lives Plus’ initiative supporting heart failure improvement work in secondary care (2008) and in January 2012-16 took up the post of Lead Nurse for the South Wales Cardiac Network. She was on the implementation board for the National Heart Failure Audit.

She is now leading on the introduction of the International Consortium for Health Outcomes Measurement standard data collection set for heart failure – a world-wide initiative - in two acute hospitals.

Game Changing – Using Research in Clinical Practice to Improve Patient Care

The aim of the presentation will be to inspire but give a realistic perspective on carrying out research and audit in the clinical arena. It will cover the Cardiac Rehabilitation and Heart Failure team’s programme of research over the last decade and by using case studies un pick the pros and cons. The benefits of a programme of research to patient care, service development and the team’s progress far outweigh the challenges.



Professor Huon Gray An Overview of National CVD Priorities

Professor Huon Gray MD FRCP FESC FACC is National Clinical Director for Heart Disease for NHS England.

Huon qualified from St Thomas’ Hospital, London in 1977 and did postgraduate doctoral research there as a British Heart Foundation Junior Fellow. His cardiology training was undertaken at the Brompton and St George’s Hospitals, London and he was appointed as consultant adult and interventional cardiologist to Southampton University Hospital in 1989.

He was President of the British Cardiac Society (2003-5), and was awarded its Mackenzie Medal in 2014. He co-chaired the UK National Infarct Angioplasty Project [NIAP] (2004-8), was clinical adviser to the National Institute for Health & Care Excellence (NICE) on acute coronary syndromes (2007-10), and chaired its guideline on ST elevation myocardial infarction (2011-13). He chaired the International Council of the American College of Cardiology (2008-13) and sat on the ACC’s Board of Trustees (2012-16). He was awarded the ACC’s Presidential Citation in 2013.

Huon is honorary professor at Queen Mary’s University, and University College, London, and has published on various aspects of cardiology and health service delivery. He was Deputy and then Interim National Clinical Director for Heart Disease at the Department of Health (2007-12), and was appointed National Clinical Director for Heart Disease by NHS England in 2013

An Overview Of National CVD Priorities

The UK has seen a remarkable reduction in mortality from cardiovascular disease over the last 20 years, but comparative analyses (such as the Global Burden of Disease Study 2010 published in the Lancet) showed that our achievements have been less than those of our European neighbours. Clearly cardiovascular disease remains an important determinant of health and wellbeing and it was for this reason that the Department of Health developed its Cardiovascular Disease Outcomes Strategy (CVDOS), which was published in March 2013.

The CVDOS listed ten main action points, and these align well with objectives laid out in the Five Year Forward View published by NHS England, Public Health England and other arms length bodies. The success in reducing premature mortality from CVD has resulted in a welcome increase in life expectancy, but along with this increase in the older population comes increased CVD morbidity, particularly due to coronary and valve disease, and heart failure. This talk will cover CVD priorities and opportunities for effecting change and service improvement at a time of great financial constraint.



Dr Nicola Guess New Developments in Dietary Management of Diabetes

Dr Nicola Guess is a lecturer at Kings College London and an honorary researcher at Imperial College London. Her research interests are in the role of nutrition in the prevention and management of type 2 diabetes, specifically how the underlying pathophysiological differences may influence the effectiveness of dietary interventions to manage glycaemia. She has been the chief investigator of 4 clinical trials examining the effect of diet on glucose homeostasis, and also carries out epidemiological studies to complement findings from physiological trials. Prior to moving into research, Nicola was a community dietitian at Newham General Hospital for 3 years.

New Developments in Dietary Management of Diabetes

The primary goal for diabetes nutrition care is to integrate nutrition therapy into the management of diabetes in order to improve glycaemic control, blood lipids and blood pressure and reduce the risk of potential diabetes-related complications. There is extensive evidence to show that nutrition interventions improve metabolic outcomes in diabetes; beneficial effects on haemoglobin A1c are most consistently demonstrated but other positive effects (e.g. lipids, blood pressure, weight and quality of life) are also reported. In recent years there has been a shift in emphasis in the nutritional management of diabetes; historically nutrition advice focused on the quantity and type of carbohydrate in the diet whilst the most recent UK evidence-based nutrition recommendations focus on the importance of weight management in diabetes care and a move away from carbohydrate-centric advice. The most effective diet to help diabetes patients achieve weight loss is the subject of debate and controversy however, it is clear that a personalised approach that offers the individual advice they find enjoyable and acceptable is more likely to succeed.



Michele Gray Psychology in Health Behaviour Change and Weight Management

I am a Chartered Psychologist, a member of the British Psychological Society, the Division of Health Psychology and a registered Practitioner Psychologist with the Health Professionals Council. I am also a Visiting Fellow at the University of South Wales Pontypridd.

I work across ABMU as a Specialist Health Psychologist and have an interest in chronic condition management and rehabilitation; mainly within cardiac rehabilitation, bariatric and weight management services. I see patients individually and also deliver group psychological education sessions addressing factors such as stress management, sleep difficulties, relationship issues, coping with long-term change and healthy life-style choices.

I am involved in the support and training of psychology workplace students, and the in-house training in psychological aspects of physical health for staff from other disciplines (i.e. ABMU dietetic and physiotherapy departments).

Professionally many of my patients have multiple, chronic, life-changing health conditions which often necessitates adapting to physical changes within their life-style. Vocationally; I coach both able-bodied and disabled archers, including some with high levels of physical disability and wheelchair users.

Psychology in Health Behaviour Change and Weight Management

This presentation will explore common factors surrounding recognition of risk factors and lifestyle issues in cardiac patients. In this presentation I will be using my experience of working both within cardiac rehabilitation and weight management services to look at ways of addressing long term behaviour change and explore barriers to change that patients commonly face; with a specific emphasis on weight management.

The aims and objectives will be to investigate health behaviours in general, and discuss eating behaviours and weight management in more detail. I will be looking at some of the more complex relationships people can have with their unhealthy behaviours and suggesting ways in which health professionals can help patients identify and address these.



Dr Patrick Donnolly The Emerging Role of Cardiac CT for Risk Stratification and Prevention.

Patrick Donnelly MD, MB BCh BAO, FRCP.

Dr Patrick Donnelly is a consultant cardiologist in the South Eastern Health and Social Care Trust. He is director of Cardiovascular Imaging, Cardiovascular Research, Cardiac CT Programme and the Ards Heart Start Programme.

He is a Reader and Honorary Senior Lecturer at Queen’s University Belfast. He received his medical degree from Queen’s University Belfast and completed higher speciality imaging training at Harvard University and the Massachusetts General Hospital, Boston USA. He is Co-clinical Lead of the NI Cardiovascular Research Network and sits on the National Cardiovascular Atherothrombosis Research Group



Frances Divers Scottish Government Cardiac Rehabilitation Modernisation Agenda

Frances Divers is a Cardiology Nurse Consultant and Lead Cardiac Rehabilitation (CR) Clinician at NHS Lothian in Scotland. She has worked in the field of Cardiology for over 30 years and has dedicated much of her career to Cardiac Rehabilitation services. Frances has been involved in the development of key national standards and guidelines and is a key stakeholder to the implementation at local level. Over the years she has developed good links with agencies outside the NHS such has BHF and CHSS working in partnership to promote and move forward key innovations. In 2014 she was appointed by the Scottish Government as Clinical Champion for Cardiac Rehabilitation in Scotland with the main objective of driving the CR modernisation agenda in Scotland forward. She is currently the chair person to the Cardiac Rehabilitation Interest Group for Scotland (CRIGS) continuing to support the ethos of promoting evidence base practice and education for staff working in cardiac rehabilitation.

Scottish Government Cardiac Rehabilitation Modernisation Agenda

The Scottish Government (SG) published The Heart Disease Improvement Plan 2014 in August 2014 which makes a commitment to further improve Heart Disease Management and Rehabilitation in Scotland. Priority 4 of the Plan outlines the Scottish Government’s aim to support people with Heart Disease to live longer, healthier and independent lives.

To drive this forward within Cardiac Rehabilitation (CR) a Clinical Champion for CR was appointed by the SG to promote the 2020 CR Vision as the new model of delivery across Scotland.

The purpose of this session is to showcase some of the work currently being undertaken in Scotland aligned to the modernisation agenda. The session will outline the 2020 CR Vision as the model of delivery for CR in Scotland. It will discuss key findings, recommendations and agreed priorities following a CR scooping exercise of all 14 Health Boards in Scotland. The session will provide an opportunity to share and discuss current innovations aligned to the modernisation agenda across Scotland.



Dr Will Man / Dr Rod Taylor Debate: Generic versus Specialist Rehabilitation

Dr William Man is Consultant Chest Physician at the Royal Brompton & Harefield NHS Foundation Trust. He is medical lead for the Harefield Pulmonary Rehabilitation Unit which receives over 1200 referrals a year and delivers pulmonary rehabilitation in hospital and community settings across northwest London.

As well as being a full time NHS clinician, Dr Man is a clinician scientist and has received personal fellowship funding from the National Institute for Health Research and the Medical Research Council. Dr Man has a particular research interest in skeletal muscle dysfunction in COPD and pulmonary rehabilitation, and recently was on the Guideline Development Group for the British Thoracic Society Guidelines on Pulmonary Rehabilitation and the writing committee for the joint American Thoracic Society and European Respiratory Society Executive Statement on Pulmonary Rehabilitation.

For

The aging population was the 20th century’s greatest triumph, but is also now the 21st century’s greatest challenge. Current health systems have developed with a specialist organ focus but are now wholly inadequate to deal with the complex needs of the older patient where multi-morbidity is the norm. Breathlessness is a common disabling symptom in older people, with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) the most common causes. The patient with CHF has similar needs to the patient with COPD, and may be better suited to a breathlessness rehabilitation programme compared with a traditional cardiac rehabilitation program designed for post-myocardial infarction patients. The growing evidence base for a “generic”, symptom-based rehabilitation approach will be reviewed.



Dr Rod Taylor

Rod Taylor, MSc, PhD is Professor of Health Services Research at Medical School, University of Exeter, Director of Exeter Clinical Trials Unit, and National Institute for Health Research (NIHR) Senior Investigator. He is an Adjunct Professor at National Institute of Public Health in Copenhagen. His former academic appointments include the London School of Hygiene and Tropical Medicine and the Universities of Birmingham and Glasgow and he was first Director of Technology Appraisals at the National Institute for Health and Care Excellence (NICE).

He has published over 250 peer review articles the field of health services research and health technology assessment. Rod’s main research interests include clinical trial design for complex interventions, the use of surrogate outcomes in clinical trials and reimbursement policy, development and evaluation of secondary prevention and rehabilitation strategies for heart disease, and the evaluation of the comparative effectiveness of medical devices.

His postgraduate qualifications include PhD Clinical Physiology (Glasgow), MSc in Medical Statistics (London) and Postgrad. Dip. Health Economics (Aberdeen). He is currently Chair of NIHR Research, Health Service & Development Research Panel, and member of Core member of NIHR HTA Themed Call Board, NIHR Health Services and Delivery Research Researcher-Led panel, 2013-present and Core group of Methodological Experts for the NIHR Programme Grants for Applied Research programme and the Medical Research Council Methodological Research Panel. He is member of editorial board for International Journal of Technology Assessment in Health Care, European Journal of Preventive Cardiology, Pain Practice, Neuromodulation, Cochrane Heart Group and acts a methodological reviewer for a number of peer review journals.

Against

The concept of ‘generic rehabilitation’ - the combined provision of rehabilitation to groups of patients with either common symptoms (e.g. breathlessness due to heart failure or COPD) or common aetiology (e.g. CVD basis of myocardial infarction or stroke) - has been proposed to be an efficient approach to the future provision of rehabilitation in UK. However, as I will argue in this debate, there is little or no clinical underpinning, theoretical basis, or evidence base to support a move to genericise our rehabilitation services; instead we must stay with our evidence-based, tried and tested, and distinct and separate models of cardiac, stroke, and pulmonary rehabilitation!


Main Conference Sessions Speakers Session 10; Friday 10.50 – 11.30

Professor Sanjay Sharma Keynote: Assessing and Managing the Health of the Young Athletic Heart predisposed to Myo-neural Dysfunction

Professor Sanjay Sharma is Professor of Cardiology and Lead for the Inherited Cardiomyopathies and Sports Cardiology Unit.

He is also the Medical Director for Virgin London Marathon, Consultant Cardiologist for the charitable organisation Cardiac Risk in the Young (CRY), and Cardiologist for the English Institute of Sport, British Rugby League and the British Lawn Tennis Association.

Professor Sharma has an international reputation in cardiovascular adaptation in athletes, sudden cardiac death in the young and heart muscle diseases. His research has been pivotal in characterising the impact of age, sex and ethnicity on cardiovascular adaptation to exercise and in the identification of non-invasive methods of differentiating electrocardiographic and echocardiographic manifestations of cardiomyopathy and ion channel disorders from those representing ‘athlete’s heart.’

His current research programmes include the assessment of the impact of long-term ultra-endurance sport on the heart, ethnic differences in phenotypic manifestations in cardiomyopathy and ion channel diseases, right ventricular adaptation to exercise and sudden arrhythmic death syndrome.

He conducts four large tertiary clinics in inherited cardiac diseases and sports cardiology each week. He is responsible for the CRY pre-participation screening programme in athletes which serves the English Institute of Sport and numerous other independent sporting organisations. A sports cardiology centre has been established recently at St George’s Hospital, serving athletes with symptoms suggestive of cardiovascular diseases and those deemed to have abnormalities on the ECG or echocardiogram.

Professor Sharma joined St George’s in 2010. He is senior tutor for the international teaching faculty for the Royal College of Physicians and a Lecturer on the RCP MRCP (II) written course. He has published several educational books in medicine and cardiology including ‘Self assessment Colour Review of Cardiology’ and ‘Rapid Review of Clinical Medicine for the MRCP Part 2’.



Prof Patrick Doherty (BHF Research Group, University of York) / Dr Ahmad Salman To what extent does cardiac rehabilitation meet national minimum standards for service delivery?

Professor Patrick Doherty is Chair of Cardiovascular Health in the Department of Health Sciences at the University of York and Director of the National Audit of Cardiac Rehabilitation. He has over 30 years of clinical and research experience within the NHS alongside significant European experience. He was the NHS Clinical Lead for Cardiac Rehabilitation (2008 to 2012) where he supported service innovation and led the development of the Department of Health ‘Cardiac Rehabilitation Commissioning Pack’. Prof Doherty is a past president of the British Association for Cardiovascular Prevention and Rehabilitation and Chair of the ‘Cardiac Rehabilitation Section’ of the European Association for Cardiovascular Prevention and Rehabilitation (2014-2016). Patrick and the NACR Team are supporting the joint BACPR/NACR Certification programme which aims to ensure that all cardiac rehabilitation programmes are working to the agreed minimum clinical standards. He has published over 20 peer reviewed papers in the last two years and his work is helping define and achieve high-quality service delivery for the benefit of all eligible patients.

Doctor Ahmad Salman is a cardiology prevention and rehabilitation specialist in the Cardiac Diseases Center in Kuwait. He is responsible for providing evidence-based physical activity advice and managing intervention programmes for patients at risk of, or suffering from, a variety of cardiovascular disorders. Ahmad’s prior experience includes working as a junior practitioner, a clinical trainee in the Ministry of Health of Kuwait, in medical departments, as well as running the phase IV clinic at Essex University, UK. Ahmad came to the University of York in January 2015 to study his PhD in the field of cardiac rehabilitation and prevention supervised by Professor Patrick Doherty. The aim of his PhD is to identify and better understand factors that determine high and low performing rehab programmes from two distinct perspectives namely service delivery and patient outcomes.

To what extent does cardiac rehabilitation (CR) meet national minimum standards for service delivery? Authors: Doherty P, Salman A, Furze G, Dalal H, Harrison A

The session will present data from the National Audit of Cardiac Rehabilitation (NACR) set against six measurable standards important for the delivery of high quality CR programmes. A score of 1 point was allocated for each single minimum standard met with a total of 6 possible points available. The performance of CR programmes was categorised into three groups: high (score of 5-6), middle (score of 3-4) and low (scores of 1-2).

Data for the period 2013-14 from 170 CR programmes revealed that around a third of programmes achieved high performance status, about 46% were in the mid-level category and around 20% were in the lower-level category.

This analysis, of NACR data, shows that high levels of performance is achievable in the era of modern cardiology and that many CR programmes are close to meeting high performance standards. That said substantial variation, below the recommended minimum standard, exists throughout the UK. BACPR/NACR National Certification should be seen as a positive step to quality assuring CR services.

The NACR is supported by the British Heart Foundation



Professor Nick Ossei-Gerning Save your Sex Life, Save your Heart

Professor Nick Ossei-Gerning did his basic training at University College Hospital, London. His initial training in General Medicine was in London and then subsequently in Yorkshire. He did General Cardiology primarily based at the Yorkshire Heart Centre. His interventional training was initially in Yorkshire Heart Centre and subsequently at the University of Alberta in Canada. His MD Thesis gained at the London University was on Genetic polymorphisms and the risk of coronary artery disease. Other areas of interest included coagulation and fibrinolysis, infection and insulin resistance and risk of coronary disease. He is currently a Consultant Interventional and General Cardiologist at the University Hospital of Wales in Cardiff. He is the lead clinician for the Chest Pain Service.

His has pioneered many new technologies in Complex Coronary Intervention in Wales including the use of Lasers and Rotational Arthrectomy.

He leads the Resistant Hypertension Group in exploring Interventional methods in the treatment of Resistant Hypertension.

His other sub-specialty interest is in Erectile Dysfunction and Vascular disease. He Chairs a Multi-disciplinary ED Service in Cardiff. He pioneered Pudendal stenting for Vasculogenic ED. He is on the board of the International Consultation for Urological Diseases and British Society of Sexual Medicine. He organised and Co-Chaired the first International Convention for Internal Pudendal Stenting for ED in Cardiff.

He is a national and international Speaker on many aspects of general and Interventional Cardiology, and is actively involved in the training of medical students and doctors.

He is on the Medical Advisory Board of Spire, Cardiff, and the Network Advisor for the Royal College of Physicians and British Cardiovascular Interventional Society. He is on the Executive Board of the Welsh Cardiovascular Society.

He was appointed The Silas Dodu Distinguished Visiting Professor of Cardiology at the University Hospital of Cape Coast, Ghana in April 2015.

He has recently been awarded an Honorary Professor of Practice at the University of Wales Trinity Saint David.



Alex Gigg and Maria Davies The Role of the Occupational Therapist in Cardiac Rehabilitation

Alex Gigg – BSc. (Hons) Occupational Therapy – Cwm Taf University Health Board

Alex is an Occupational Therapist and began work in North Glamorgan NHS Trust in 2005 (now known as Cwm Taf University Health Board). Alex has worked in Cardiac Rehabilitation for the last 3 years following a range of roles across different specialties. He has had success with re-establishing the occupational therapy service in cardiac rehab for the health board at Royal Glamorgan Hospital and has built up another service out of Prince Charles Hospital, in order to provide equitable services across Cwm Taf. Alex has had recognition for his work and at the recent BHF Alliance Awards he won the ‘Rising Star’ award and achieved a highly commended award in ‘Leadership and Engagement’. Alex also represents the Welsh occupational therapy group at the All Wales Cardiac Rehabilitation and Heart Failure Working Group. He is passionate about his work and has been able to share this with other cardiac rehab OTs by presenting at a recent joint College of Occupational Therapists (COT) and BACPR networking event for occupational therapists in the UK. Alex is due for the completion of his MSc in September 2016, where he has been studying Advancing Healthcare Practice and completing a service improvement project looking at how occupational therapy input could improve quality of life and functional outcomes for patients living with heart failure

Maria Davies, BSc. (Hons) in Occupational Therapy, Aneurin Bevan University Health Board.

Maria is a Cardiac Rehabilitation and Heart Failure Occupational Therapist. She has over 28 years NHS experience and has been working for the North Gwent Cardiac Rehabilitation and Heart failure service for the past 7 years. Maria is passionate about her role as an Occupational Therapist which can include supporting patients with engagement in everyday activities, pacing, energy conservation, stress and anxiety management. She has been successful in promoting this role on the BHF website and has contributed to an article in the Heart Matters magazine. Maria advocates that Occupational Therapists have an understanding of the physical and psychological aspects of health and wellbeing. This together with the role that they have within cardiac services plays a key part in empowering patients to engage in and maintain positive lifestyle changes, including returning to work. Maria has a keen interest in employment issues and has been successful with developing a ‘remain in and return to work’ support network for cardiac patients within the North Gwent area. Finally, Maria’s goal is to continue to develop employment support for cardiac patients and highlight the benefits of incorporating the role of an Occupational Therapist within Cardiac and Heart Failure Services across Wales.



The Role of the Occupational Therapist in Cardiac Rehabilitation

The prudent healthcare agenda encourages us all to work smarter and to enable individuals to make best decisions about their health care - occupational therapists are a key member of the team in ensuring this is delivered.

Living with heart disease can have a significant impact upon an individual’s physical, psychological and social well-being. The psychological impact alone can be enough of a barrier to participation in everyday activities that are meaningful to them and were previously deemed ‘normal’. Occupational Therapists being dual trained have the skills and expertise to address the needs of the whole person, with their aim being to make the most of the resources each individual inherently possesses within themselves in order to co-produce goals and plans that enable them to overcome any barriers preventing them from doing the activities (occupations) that matter through the use of evidence based practice. We believe that this ‘whole person’ approach is not only excellent value for money in healthcare, but adopts a ‘work smarter’ approach due to the range of interventions and input that can be offered from within one profession.

Although occupational therapy is multi-faceted in it’s approach which will be summarised, this talk will focus on one particular aspect of input - enabling individuals to return to work to demonstrate the role occupational therapy can play.



Dr Mike Knapton BHF: Research Into Practice

Dr Mike Knapton, Associate Director (Prevention Survival and Support) British Heart Foundation

Dr Mike Knapton joined the BHF in January 2006, from a clinical background. He trained as a GP at Cambridge University, and has significant experience in Primary Care roles, especially working with heart patients. He has held a number of roles in the NHS including, general practitioner, GP Tutor, Chairman of the Cambridge City Primary Care Trust (PCT) Professional Executive Committee, PCTs’ Medical Director in 2004. More recently he was appointed as a non-executive director of Cambridge Hospitals NHS Foundation Trust.

As Associate Director (Prevention Survival and Support) at the BHF, Mike is responsible for initiating innovative programmes for all people at risk of, or affected by, heart disease, and leads the charity’s efforts to prevent avoidable heart disease, save lives and maximise recovery and quality of life. He is also a much sought-after spokesperson in media work for the BHF’s health campaigns.

BHF: Research Into Practice

The British Heart Foundation mission is to win the fight against cardiovascular disease, and our vision is a world in which people do not die prematurely or suffer from cardiovascular disease. In order to achieve this, we will focus our work and investment on research. Our Research strategy 2015 to 2020, published last year, sets out how we do this. This focus on research also informs our approach to prevention of cardiovascular disease, improving survival following an out of hospital cardiac arrest and support to people living with heart disease. This presentation will illustrate these strategic ambitions by reference to some of the BHF programs of work, including the approach we are taking to integrated care, long term condition management, rehabilitation and prevention. Supporting the NHS work force in delivering these aims is critical and the BHF Alliance is how we are working to do this.



Dr Michael Thomas The Public Health Wales Strategic Plan: Supporting Cardiovascular Disease Prevention

Dr. Michael Thomas is a Consultant in Public Health Medicine in the Public Health Wales NHS Trust and the Hywel Dda Public Health Team. He is a joint lead for Cardiovascular Disease and led the Health Needs Assessment to inform the Heart Disease Delivery Plan. He is a co-founder of Prosiect Sir Gâr, a Cardiovascular and Diabetes Risk Reduction Project, which was a finalist in the NHS Wales Awards in 2014, and he has co-authored journal articles related to the Project.

He has successfully led the improvement of a number of health services locally including the restructuring of general surgical services, establishing a minor stroke clinic, creating new consultant posts in rheumatology and neurology following service reviews and creating a fully integrated sexual health service. He jointly chairs the Carmarthenshire Foundations 4 Change Programme Board which is aimed at County Teams and is about delivering better health and well-being for the population of Hywel Dda University Health Board, improving outcomes and reducing health inequalities. He has an interest in medical education and lectures at the College of Medicine at Swansea University. He is the Chair of the BMA Welsh Committee for Public Health Medicine and represents the Committee on BMA Welsh Council and on the BMA Public Health Medicine Committee UK. He is also a member of the Welsh Medical Committee which is part of the Professional Advisory Structures in Wales.

The Public Health Wales Strategic Plan: Supporting Cardiovascular Disease Prevention

Cardiovascular disease (CVD) and type 2 diabetes (T2DM) remain two of the major health challenges facing the United Kingdom. Almost one third of all deaths in the United Kingdom are currently attributable to CVD and latest figures also report that just over 3 million individuals are estimated to be living with diabetes in the United Kingdom with a further 1 million individuals yet to be diagnosed.

The National Institute for Health and Care Excellence have acknowledged these concerns and recommend the screening of individuals to identify those at ‘high risk’ of either CVD or T2DM. More locally, there are a number of Welsh policies that prioritise both CVD and T2DM. For example, ‘Together for Health – A Heart Disease Delivery Plan’ has six principle themes and the first three in particular attempt to make prevention a priority:

• DeliveryTheme1:Promotionofhealthyhearts. • DeliveryTheme2:Timelydetectionofheartdisease. • DeliveryTheme3:Fastandeffectivecare.

‘Together for Health - A Diabetes Delivery Plan’ again contains a similar theme with ‘Preventing Diabetes’ and ‘Detecting Diabetes Quickly’ two of the main outcomes that the policy document is attempting to achieve.

Through the delivery of the Public Health Wales Strategic Plan, Public Health Wales has led the Health Needs Assessment process which has informed the local Heart Disease Delivery Plans to ensure that the needs of the population are met and that approaches to reduce inequities in health due to cardiovascular disease are implemented. The actions through the integrated models of smoking cessation service delivery, increasing physical activity, tackling obesity and alcohol consumption will all improve population outcomes.

With an increased emphasis on the prevention and management of CVD and T2DM through guidelines and targets, occupational health services have provided an excellent opportunity to explore the provision of primary prevention risk assessment and management to the workforce in Carmarthenshire through Prosiect Sir Gâr.


Main Conference Sessions Speakers Session 11; Friday 15.05- 15.35

Dr James Barry / Rachel Owen Cardiac Prevention and Rehabilitation – the State of the Nation

Rachel Owen, Clinical Nurse Specialist Cardiac Rehabilitation

I have worked in the Cardiac Unit at the University Hospital of Wales, Cardiff since qualifying in 1988. Initially, I worked on the Cardiology ward then further developed my knowledge and skills on Coronary Care. I joined the small Cardiac Rehabilitation team in 1997 and became team leader in 2002. I find working in Cardiac Rehabilitation extremely rewarding and quite challenging at times and feel very fortunate to thoroughly enjoy my job. I have recently been appointed, 2 sessions per week, as Cardiovascular Lead Nurse on the South Wales Cardiac network. The purpose is to support Cardiac Rehabilitation and Heart Failure teams in South Wales in service development in line with the All Wales Heart Disease Priorities and Delivery Plan.

Dr James Barry

Completed Cardiology training at Bristol before pursuing a post training fellowship at Southampton. Appointed Consultant Cardiologist at the Cardiac centre Morriston hospital in 2009.

Cardiac Prevention and Rehabilitation – ‘The State of the Nation.’

In Wales, there has been a steady decline in the rate of people dying from all Cardiovascular Disease (CVD). Just over 10,000 people in 2010 died from CVD and by 2014 this had fallen to just over 8,800 deaths. In 2014 Coronary Artery Disease was the cause of 3,992 deaths.

Smoking rates continue to fall; 19% of adults in Wales are regular smokers. Time and resources have been invested to improve the identification and management of cardiovascular risk factors.

In Wales, an extra 180 (4% increase) patients attended Cardiac Rehabilitation in 2014-15 an uptake of 42%. The All Wales Cardiac Rehabilitation baseline review identified differences in staffing and exclusion of specific patient groups such as heart failure. The teams are working towards achieving the BACPR Certification.


Parallel Sessions Speakers Session 8; Friday 9.45 – 10.15 BACPR Nurses Forum / Psychology Sessions

Dr Janet McKay The Ayrshire Healthy Active Rehabilitation Programme (HARP)

Dr Janet McKay has more than 30 years experience in the NHS. She has worked in cardiac care in Ayrshire since1988, and in Cardiac Rehabilitation since 1990. She was one of the first to be appointed to this field in Scotland. She has a MSc from the Open University and a Doctorate in Nursing from the University of Stirling. Her current post is Consultant nurse Cardiac care, responsible for cardiac rehabilitation, chest pain and heart failure services within NHS Ayrshire and Arran. She has supported several research projects within the team, currently these include CHD in the prison population, development of a patient reported outcome measure and self-care and quality of life in Heart Failure. She has lectured at both Glasgow Caledonian and West of Scotland universities and is currently working with the University of Stirling on a masters module in cardiac care and treatment. Since 2010, Janet has also been elected by healthcare professionals as a Non-Executive Director of NHS Ayrshire and Arran Health Board.

The Ayrshire Healthy Active Rehabilitation Programme (HARP)

Over two million people in Scotland have long term conditions and this number is projected to rise as the population ages. Most people with multi-morbidity in Scotland are under 65 years. Current evidence suggests that deprivation influences both the amount and the type of multiple conditions that people experience. Previous NACR data analysis (NACR 2013) has shown that an increasing number of co-morbidities is associated with reduced outcomes following CR compared to patients with less co-morbidity.

A team of multi-agency staff in Ayrshire and Arran set out to collaboratively develop and test a new model of rehabilitation for people living with multiple conditions (HARP). The team used the extensive evidence base for several single disease rehabilitation services to develop a new innovative programme for those coping with multiple conditions. This programme is currently being tested and over 300 individuals have been referred. This presentation will describe the programme and the outcomes that have been achieved so far.


Parallel Sessions Speakers Session 9; Friday 9.45 – 10.15 BACPR Exercise Professionals Group / Dietetics

Professor John Buckley Position Statement on Exercise Considerations for the Cardiac Rehab Participant with Diabetes

Prof John Buckley BPE, MSc, PhD, CSci, FBASES, FHEA Professor of Applied Exercise Science, University Centre Shrewsbury

John’s post-doctoral work has included collaborative published research with Emeritus Professor Gunnar Borg, inventor of the Borg ratings of perceived exertion scales.

His experience over the years in exercise testing and prescription includes performing over 7500 functional capacity tests to clients, patients and athletes for individual exercise programmes. In addition to helping cardiac patients and exercise referral clients, he has helped hundreds of people train for half- and full-marathons following functional testing.

In 1988 John, as a Founding Managing Partner, started the Lifestyle Exercise & Physiotherapy Centre, Shrewsbury. For 21 years this business not only involved a specialist fitness centre and physiotherapy clinic, it provided contracted services in Exercise & Physiotherapy to the local PCT and Hospitals, including John’s front-line work as an Exercise and Cardiac Rehabilitation Specialist at the Royal Shrewsbury Hospital and the University Hospital of North Staffordshire. For 17 years from 1989 to 2006, his work was linked with teaching and research in the Physiotherapy School at Keele University. As Professor of Exercise Science he is a lead lecturer on the MSc Cardiovascular Health and Rehabilitation at the University of Chester and Programme Lead for BSc Health and Exercise Science and MSc Exercise Medicine at the new University Centre Shrewsbury.

For 14 years he was the Exercise Physiology Consultant to the national McArdle Disease and Neuromuscular Clinic now based at the University College Hospital London. John has authored and edited textbooks, numerous chapters in BACPR, BASES, and sports medicine manuals/guidelines, and he has published research in internationally renowned journals in the area of perceived exertion, exercise testing and prescription, and more recently on the effects of sedentary work on cardiometabolic health.

Position Statement on Exercise Considerations for the Cardiac Rehab Participant with Diabetes.

Diabetes (mainly type 2) is now prevalent in over 30% of people attending cardiovascular prevention and rehabilitation programmes in the UK. Especially for individuals with both CVD and Diabetes, leading a physically active lifestyle is paramount in managing disease prevention and reducing progression along with maintaining a good quality of life. Exercise professionals are increasingly being challenged with advising, leading, and guiding people’s activities which are required to dually benefit both cardiovascular and metabolic health status. This includes medical considerations, and nutritional and drug interactions that may need additional exercise adaptations. As with any lifestyle related condition, increasing or changing health behaviour lies at the heart of any programme and yet by default many current risk assessment thresholds related to exercise in clinical populations may be inadvertently misinterpreted or misperceived by the participant as reasons not to participate. This presentation aims to cover these elements which will form part of a new international position statement currently being developed

• ProgrammeandResearchLeadforActiveLivingandExerciseMedicine

• FellowoftheHigherEducationAcademy• FellowoftheBritishAssociationofSport&ExerciseSciences

(BASES)• Chartered Scientist; BASES Accredited Exercise Physiologist• FoundingChair,InternationalCouncilofCardiovascular

Prevention and Rehabilitation

• PastPresidentBACPR(2009-2011)• Founding Committee Member of BACPR-EPG (2001 – date)• TutorformanyBACPRCourses• PastChairofBASESDivisionofPhysicalActivityforHealth

(2004 - 2008)• FoundingChairofBASESExerciseforHealthPractitioners’

Interest Group• Exercise Physiology Advisor to Skills Active Level 4 Standards


Lunchtime Symposia and Workshops

Thursday 6th October 2016 10.00 – 11.00

Meeting BACPR/NACR Certification Standards1. How to optimise NACR data input to help meet national certification programme (NCP_CR) criteria2. New and emerging data requirements for the NCP_CR3. Ongoing NACR projects - Scotland, SystmOne4. Q&A session

Thursday 6th October 2016 13.00 – 14.00

♥ Ballroom The Importance of Lipid Management in ACS patients Dr June Shahid, Consultant Cardiologist, Sunderland City Hospital.

Latest evidence and guidelines relating to lipid management in the high risk patient. Update on recent ESC Hyperlipidaemia guidelines, need to treat to lower targets. Options to reduce cholesterol beyond statins. Practical considerations when treating/ re-evaluating lipids to achieve targets post ACS.Sponsored by MSD

♥ Sophia Room Medicine Optimisation in Cardiac Rehabilitation Workshop The workshop will lead you through the opportunities and barriers in the prescribing of cardioprotective medications. You will be encouraged to explore what is required of you in this element of cardiac rehabilitation and to consider how you might be involved in this in your own service.

Bernie Downey / Jacqui Cliff

♥ Exhibitor Area Country Area Stations Please visit these as we hope these will provide an excellent networking opportunity and the chance to find out about, and share developments within your country


Lunchtime Symposia and Workshops

Friday 7th October 2016 12.45 – 13.45

♥ Ballroom Right care, right treatment post MI The Long term risk for patiemts post MI , Dr Joe Mills

Medicines Optimisation post MI , Dr Rani Khatib

The ‘One Heart’ patient support programme, Hetty McConnen

Sponsored by AstraZeneca

♥ Sophia Room Occupational Therapy Workshop Relaxation /CBT

This workshop will provide an introduction into cognitive behavioural therapy approaches that can used to enable your patients to manage unhelpful thoughts and behaviours which may be limiting their cardiac rehabilitation progress. There will also be opportunity to explore a range of relaxation techniques for your cardiac rehabilitation patients and discuss their suitability for use within a group setting.

Sarah Quinlan and Jo Hayward

♥ Exhibitor Area Country Area Stations Please visit these as we hope these will provide an excellent networking opportunity and the chance to find out about, and share developments within your country.


Alison Atrey

Alison has been a state registered dietitian since 1996 and has specialised in cardiology since 2000. She is currently working as the programme lead for the MSc in Preventive Cardiology at the National Heart and Lung Institute. She was the dietetic coordinator for EUROACTION, a cluster RCT of a nurse led multidisciplinary family centred preventive cardiology programme conducted in eight countries and 24 centres in Europe between 2002 and 2006. She provided dietary input into the third and fourth EUROASPIRE surveys, the British Cardiovascular Society sponsored Aspire-2-Prevent survey based in the UK; and the EUROACTION plus intensive smoking cessation with varenicline which was implemented in 4 countries including the UK.

She was part of the team that set up the MSc/PG Dip/PG Cert and short courses in Preventive Cardiology at Imperial College London where she teaches in nutrition and weight management. She leads the modules in nutrition and weight management coordinates the masters research projects. She completed her PhD on pan european cardiac prevention and rehabilitation: impact on dietary change in 2013.

She was the chairperson for the UK Heart Health and Thoracic Dietetics Specialist group of the British Dietetic Association Group. She published the updated UK guidelines for diet and secondary prevention of cardiovascular disease in 2006 and has contributed to the BACPR standards and a number of books in the field of nutrition and preventive cardiology. Alison represented the BDA for the DH & BHF cardiovascular coalition, the post MI NICE guidelines and was co-expect member of the Cardiovascular Risk NICE guidelines. She was awarded the Role of Honour from the BDA for her contribution to dietetics in 2006 and 2009.

Brian Begg

Brian, a Sport and Exercise Science graduate from the University of Limerick (Ireland), has worked in Cardiac Rehabilitation since 2005. He qualified as a BACPR Instructor in the same year, and has been a BASES Certified Exercise Practitioner since 2012.

Brian currently works for the Cardiac Rehabilitation team of Aneurin Bevan University Health Board (South East Wales) and the Countryside Service of Caerphilly County Borough Council in an innovative partnership post. Brian sits on the BACPR Council as the elected Exercise instructor representative; he chairs the BACPR Exercise Professional Group and the BACPR Exercise Instructor Network.

Chairpersons


Jacqui Cliff

Jacqui has worked as a nurse in cardiac care for over 20 years. Currently the lead nurse for Betsi Cadwaladr University Health Board’s East cardiac rehabilitation service, Jacqui’s passion is for offering holistic and patient-centred care. In her career Jacqui trained as a practice nurse then lecturer giving her opportunity to update and revamp the cardio-vascular modules and resuscitation training for student nurses in North East Wales. More recently Jacqui graduated from Glyndwr University with MSc in Advanced Clinical Nursing Practice where she gained her qualification as non-medical independent prescriber. Last year Jacqui was pleased to have been elected as a BACPR ordinary council member where she feels she can have a greater input into cardiovascular prevention and rehabilitation in the UK.

Dr Aynsley Cowie, Scientific Officer

Aynsley joined the BACPR council in December 2014, taking up the role of Scientific Officer immediately. As chair of the conference committee, Aynsley has co-ordinated the annual conference programme for both 2015 and 2016, and hopes to continue in this role for the next two years. Aside from conference organisation, Aynsley has been leading development of the BACPR’s newest website development, the Research Network. She also acts as the BACPR reviewer for the British Journal of Cardiology.

Based within NHS Ayrshire & Arran, Scotland, Aynsley has just started a new post as consultant physiotherapist in cardiology. Her first objectives within this post are to lead a Scottish Government funded research project to develop a new patient-reported outcome measure for cardiac rehabilitation, and to assist her team in collating outcomes from the new model of multi-morbidity rehabilitation (HARP) that they are currently piloting. Aynsley has a PhD in exercise training in heart failure, and is also working to further develop the role of physiotherapy with this population in Ayrshire.

Dr Hayes Dalal

Hasnain (Hayes) Dalal is a clinical researcher having worked as a GP in Truro, Cornwall for 30 years where he was inspired by a patient to find out about more about cardiac rehabilitation. Over the years, he has developed an interest in primary care cardiology and led a RCT, funded by the NHS, comparing centre vs home based cardiac rehabilitation. He is currently jointly leading the REACH HF Study – a Programme Grant for applied research from the NIHR .He is an honorary Clinical Associate Professor with the University of Exeter Medical School and an ordinary council member of the BACPR.

Chairpersons


Bernie Downey MBE

Bernie Downey is a cardiac nurse specialist working for the BHSCT. Her main clinical interests are in cardiovascular disease management. She has extensive experience in nursing cardiac patients and has participated in research trials and nurse led advisory boards to help promote best practice in all aspects of cardiac care. She has been responsible for developing patient education tools and patient information literature and currently is an honorary lecturer for the HSC Clinical Education Centre. Bernie is an independent non medical prescriber and leads a nurse led secondary prevention service to manage cardiovascular risk factors in patients with coronary heart disease (CHD) and those at high risk of developing CHD. Non medical prescribing allows for timely and appropriate medication adjustment thereby optimising treatment of patients with CHD, hypertension, lipid management, smoking and obesity.

Bernie is past president of the British Association for Cardiovascular Prevention & Rehabilitation and previous chair of the clinical advisory group for cardiac rehabilitation and secondary prevention for the NI Regional Cardiac Network.

In 2007 Bernie was awarded an MBE for services to nursing and health care in Northern Ireland.

Sally Hinton

Sally is the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) Executive Director and Education Director responsible for supporting the BACPR executive committee across all aspects of the work of the association and responsible for the expanding education programme including the BACPR Exercise Instructor qualification, range of short courses and on line education. She is both founder chair of the ACPICR (Association of Chartered Physiotherapists interested in Cardiac Rehabilitation) and the BACPR Exercise Professionals Group committee. Sally completed an MSc in Health Promotion at Brunel University with a dissertation in patients’ compliance with exercise after cardiac rehabilitation and has many years’ experience lecturing in the field of Cardiovascular Rehabilitation. Sally was one of the authors of the BACPR Standards and Core Components for Cardiovascular Prevention and Rehabilitation (2012), a key document for the cardiac rehabilitation programmes within the UK.

Chairpersons


Annie Holden

Annie has extensive experience in strategic and operational management of Health business at National and European level, developing highly effective innovative health prevention and treatment solutions, with expertise in physical activity and cardiovascular health. Annie is now SLM’s Head of Public Health with responsibility for providing strategic direction to lead and develop dynamic and bespoke community health services, offering a holistic approach to improving the health of local communities.

As a qualified teacher and lecturer, Annie has the advantage of extensive academic experience and continues to be a Guest Lecturer at various Universities, including Imperial College London where she teaches on the Masters Preventive Cardiology course. Previously Annie worked as the Physical Activity co-ordinator in a European wide research project and then become the Director of Operations of a national initiative putting cardiovascular disease prevention first.

Annie has been a national BACPR Council member since 2012 with responsibility for competency development and is currently the Treasurer. She is also an Assessor and Course Director for the BACPR delivering the Exercise Instructor qualification and other Health Professional courses. Annie was one of the founder members of the BACPR-EPG and former committee member.

Alison Iliff Alison has worked in a range of health roles for the past 20 years and is currently Health and Wellbeing Programme Manager at Public Health England’s Yorkshire and the Humber Centre, where she leads on the children and young people and healthy ageing agendas. She started her career in the voluntary sector, in health education and communications roles at the National Society for Epilepsy and the Parkinson’s Disease Society. She has also worked in healthcare inspection and quality assurance of public health screening programmes.

More recently Alison has worked in public health within the NHS and local government, with a topic portfolio including tobacco control, Roma/EU Migrant communities, work and health, diabetes, cardiovascular health including leading on the Rotherham Heart Town five-year strategic partnership with the British Heart Foundation and managing the local Health and Wellbeing Strategy.

Alison has an MSc in Health Education and Health Promotion from King’s College London and is a Fellow of the Royal Society for Public Health.

Chairpersons


Louise Jopling

Louise Jopling (nee Peardon) is a cardiac nurse, trained in Glasgow who now works within the voluntary sector promoting cardiovascular health. Within national charity Chest Heart & Stroke Scotland, Louise held a Senior Management role, responsible for service development and campaign and worked to both establish and develop organisations to ensure opportunities for ongoing professional development. Louise has worked at a national level within Scotland, including with the Scottish Government and Parliament to raise awareness of the need to sustain cardiac rehabilitation services and also in supporting roles with a number of smaller charities and patient-led initiatives. Since 2013, Louise has been the Honorary Secretary and Chair of Membership & Communications for BACPR, with involvement in a wide variety of work and projects across the organisation.

Dr Gordon McGregor

Gordon is a Clinical Exercise Physiologist and Research Fellow at University Hospital, Coventry and Coventry University with over 15 years experience in the field of cardiovascular disease prevention and rehabilitation. In his role as a clinical academic, he combines leading NHS clinical rehabilitation services with research into the effects of exercise training in clinical populations. Recent projects have investigated left ventricular remodelling in post MI patients and the role exercise training and electrical muscle stimulation in end stage renal disease and chronic heart failure. Currently he is leading a multi-centre study investigating high intensity interval training in UK Cardiac Rehabilitation programmes (HIIT or MISS UK). He is a BASES Accredited Exercise Physiologist/Chartered Scientist, elected BACPR council member, and is the immediate past Chair of the BACPR Exercise Professionals Group. Finally, he is a director of Atrium Health, a Coventry based Social Enterprise delivering NHS clinical services, maintenance exercise programmes and a wide variety of research initiatives.

Katherine Paterson

She is currently the Clinical Lead Cardiology & Obesity Dietitian at the Norfolk & Norwich University Hospital and is interested in research. Her work now includes research as a dietitian for a semaglutide obesity trial. In 2014 she successfully completed her Masters of Research investigating Adherence to mediterranean diet and risk of incident stroke in the European Prospective Investigation of Cancer and nutrition Norfolk cohort.

She has served on BACPR council for 4 years. In that role she has particularly enjoyed taking on the communications role of Lead Editor for BACPR Connect magazine and enewsletters.

In her spare time she likes to travel and is currently learning Hungarian!

Chairpersons


Sarah Quinlan

Sarah Quinlan is a Specialist Occupational Therapist, currently co-ordinating the Heart Failure Rehabilitation programme for Cheshire Wirral Partnership, based at the Countess of Chester Hospital.

Sarah has over 10 years’ experience working within Cardiac Rehabilitation, initially as a Phase 4 instructor and exercise physiologist following completion of a Sport and Exercise science degree at the University of Bath. Sarah then chose to retrain as an Occupational Therapist, qualifying in 2012, and has since been delivering therapeutic interventions to heart failure patients.

Sarah is passionate about promoting and developing the value and role of occupational therapy within cardiac rehabilitation. As a result she applied for the position of ordinary officer on the BACPR council which commenced in June 2015. Recently she has developed links between the College of Occupational Therapy and BACPR to set up a networking day for occupational therapists currently working within cardiac rehabilitation.

Chairpersons


Oral Abstract Presentations BACPR Nurses Forum / Psychology Session 6

9.00-9.10 Measurement Of Medication Adherence Patterns Using An Ingestible Sensor In Patients Attending A Cardiovascular Prevention And Rehabilitation Programme

D Thompson, NS Peters, J Edwards, T Mackay, M Matthews, S Connolly. Imperial College London

Background

Suboptimal cardiovascular medication adherence is highly prevalent and is linked with adverse clinical outcomes. One of the difficulties in studying adherence is the lack of a “gold standard” method for its measurement. Here we describe our experience with an innovative telehealth system that measures medication ingestion by use of a biodegradable, ingestible sensor detected by an externally worn skin patch. Daily sensed dosing events are visible to patients on a tablet device providing medication adherence feedback.

Methods

Consecutive patients attending the Imperial Cardiovascular Health programme’s initial assessment were invited to participate in the study (ethical approval was obtained) and used the system for the 12 week period of their programme. Adherence was also measured by self-report as well as acceptability of the device.

Results

20 patients (20% of those invited) consented to participate and had valid data for device analysis. Overall adherence by self report was very high with only 1 out of 20 patients at the initial and final assessment respectively admitting to missing their medication. In contrast, only 55% of patients overall achieved system-determined adherence ≥80% and 3 patients who reported never missing medication had scores <40%. There were high levels of acceptability reported by the participants.

Conclusions

This integrated telehealth system using an ingestible pill/sensor demonstrated lower levels of adherence to cardiovascular medications than that indicated by self report. The technology was both safe and acceptable to patients. Larger studies are needed to determine the system’s potential for measuring and promoting adherence on a wider scale.

Figure 1



9.10-9.20After A Heart Attack: The Role Of Primary Care

F Dalal,1 C Voukalis,2 MM Gandhi,3 & HM Dalal,4

1Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK 2Sandwell and West Birmingham NHS Trust, Institute of Cardiovascular Sciences, University of Birmingham, UK 3Royal Devon and Exeter NHS Foundation Trust, UK 4University of Exeter Medical School (Primary Care), Truro Campus, Knowledge Spa, Truro, UK

Background

Discharge home 48-72 hours after an uncomplicated acute myocardial infarction and revascularisation is considered safe but can leave patients uncertain about their medication and anxious about activities they can do. Contact with the GP in the first few weeks after discharge is usual and an opportunity to promote secondary prevention and cardiac rehabilitation.

Objective

Using the latest evidence and national guidelines, to provide a review of the current advice on cardio-protective medication and lifestyle following acute myocardial infarction that can be used to promote secondary prevention and cardiac rehabilitation.

Methods

Review the literature from January 2010 - June 2016 focussing on clinical review articles in high impact peer-reviewed journals on the care of adults with acute coronary syndromes and coronary revascularisation after hospital discharge.

Findings

The updated review will provide a source of evidence for the basis of long-term cardio-protective medication; which medications to prescribe and for how long. We will look to see if the evidence is only applicable to certain age groups with a focus on avoiding polypharmacy and side-effects commonly seen in the elderly. Similarly, we will examine the evidence for advice on lifestyle measures including physical activity, diet, smoking, sexual activity and driving.

Summary

The review will provide an up-to-date, evidence-based, easily accessible source for GPs clarifying recommended cardio-protective prescriptions and lifestyle measure advice. Primary care can play a key role in promoting secondary prevention and cardiac rehabilitation in patients surviving a myocardial infarction.



9.20-9.30Meaning-Centred Psychotherapy For Physically ill Patients: Overview, And A Case Study Within A Cardiovascular Community Service

Zs. Hutchinson

Knowsley Community Cardiovascular service, Liverpool Heart and Chest NHS Foundation Trust, England.

Background

The psychological support service is aimed to monitor client’s well-being and to provide evidence based intervention to those patients with long term conditions who have moderate common mental health problems. This is a confidential service for cardiac patients who may experience emotional distress after diagnosis and feel that they would benefit from psychological support. The treatment options are individually designed to meet patients’ needs whilst creating a relaxed safe environment for those who wish to attend clinic. For those who are unable to travel the option of a home visit is also provided.

Almost 40% of long-term physically ill patients also have mental health problems, but most counselling interventions show only modest psychological effects. However, seven trials indicate large effects for Meaning-Centred-Psychotherapy (MCP). Breitbart et al have developed MCP for cancer-patients in palliative-care in New York. Vos et al are evaluating MCP for palliative-cancer, chronic-pain and cardiovascular-disease-patients in the UK, and have validated MCP for cancer-survivors in the Netherlands. MCP helps individuals to live a meaningful and satisfying life despite their illness, and comprises eight semi-structured sessions with psycho-education, exercises, and discussing meaning-in-life directly and in positive terms. This seems relevant as up to 70% of all physically-ill patients ask meaning-related questions, and experiencing-meaning-in-life improves mental-health.

Format

An overview of the clinical relevance and therapeutic model will be presented. A clinical example will be discussed how treatment of cardiac patients with MCP takes place.

Key Elements

Main outcomes will be: being able to generally understand the rationale, method and efficacy of MCP via a case study among cardiac patients within the community; exploration of issues in clinically implementing MCP.


Oral Abstract Presentations BACPR Exercise Professionals Group / Dietetics Session 7

9.00-9.10Safety And Feasibility Of High-Intensity Interval Training In UK Standard Phase III Cardiovascular Rehabilitation

Welsh, A.C., Roose, A., Evans, Z., Matata, B., Mills, J., Midgley, A.W.

Knowsley Community Cardiovascular Service, Liverpool Heart and Chest NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE

Department of Sport & Physical Activity, Edge Hill University, Saint Helens Road, Ormskirk, Lancashire L39 4QP

Introduction

High Intensity Interval Training (HIIT) has evidenced superior physiological benefits in cardiac populations, compared to Standard Care cardiovascular rehabilitation (CR). When impaired, Heart Rate Variability (HRV) and Baroreflex Sensitivity (BRS) have been shown to be associated with cardiac mortality and morbidity risk. Aims of this study are three-fold: to consider the practical and logistical application of HIIT, prescribed via the Borg 6-20 Rating of Perceived Exertion Scale (RPE) into community-based CR; to determine the efficacy of HIIT with regard to physiological and performance measures; and to assess patient psycho-perceptions and quality of life (QoL) in response to HIIT.

Methods

Thirty-four (28 males, 6 females, 60±9 years) CR patients were randomised to 8 weeks of HIIT or Standard Care. Patients were expected to perform five bouts of three minute intervals, intermittent with two minutes rest, once a week. HIIT groups were prescribed exercise at 16-17 and Standard Care at 11-14 RPE. Estimated submaximal aerobic capacity (VO2), QoL, BRS and HRV were determined pre and post-intervention. Safety and RPE were monitored continually, whilst arousal and affect perceptions were recorded post-exercise session. Exercise enjoyment was only measured post-intervention.

Results

Inferences depict significant time effects in BRS (p=0.031), estimated submaximal VO2 (p=0.022), and physical domains of QoL (p=0.005). Enjoyment ratings were perceived to be higher post Standard Care compared to HIIT (p=0.096). No interaction effects were identified between groups, due to observed similarities in exercise intensity (HIIT=12.84±1.77; Standard Care=12.63±2.12 RPE). The absence of adverse events suggests the safety of HIIT within the cardiac population.

Conclusions

This is the first trial of its nature within the UK. It provides useful experiences for community-based trials, relaying a number of limitations and recommendations for the future. There was no distinguished difference between exercise intensities, suggesting the feasibility of the Borg 6-20 RPE scale may not be suitable as an exercise prescriber within a CR environment. Similarly, the overall average attendance of five sessions presents itself as a limitation for CR adaptations.



9.10-9.20Hosting A Specialist Weight Management Service In A Cardiovascular Rehabilitation Setting: Another Useful Step Towards ‘Generic’ Rehabilitation?

R Tipson, L Murray, A Welsh, M Lynch, J Flint

Action Heart, Dudley Group NHS Foundation Trust,

Introduction

The Action Heart Cardiovascular Rehabilitation Programme (AHCRP) agreed to develop and deliver a specialist weight management service for morbidly obese patients due to its experience and success in delivering lifestyle interventions to a wide range of patient populations.

Methods

Patients satisfying the referral criteria (generally BMI >40 kg/m2) were eligible to be referred to the new service, attending the ‘Action Weight’ clinic once per week for twelve weeks. All patients were set a 5% weight loss target and were allowed to progress to a maintenance programme if they were successful in achieving this target. In line with NICE guidelines, the Action Weight Team comprised of a dietitian, a CBT counsellor and an exercise professional, all of whom were associated with the AHCRP. The participants were encouraged to exercise in the Action Heart Centre, alongside CVD patients.

Results

In the first twelve months, 93 patients started the course (female 71%, male 29%).

Of these, 27 patients (29%) dropped out prior to completing the programme, due to various medical, domestic and non compliance reasons.

At the time of analysis, 13 patients were still active in the programme.

Of the 53 completers, 27 patients (51%) were successful in achieving the 5% weight loss target, including 4 patients (8%) achieving a 10% weight loss.

Of the 53 completers, 52 had reduced their weight on completion of the 12 week programme.

Conclusion

The above results suggest a weight management programme can be hosted successfully in a cardiovascular rehabilitation setting. Indeed, the results, with this challenging group of patients, compared very favourably with the results of less complex patients in Dudley referred to Slimming World, the commercial organisation commissioned by Dudley Public Health. The cardiovascular rehabilitation environment proved to be inspiring, encouraging the majority of Action Weight patients to undertake regular exercise at the Action Heart Centre. The new weight management service also received appropriate ‘cross-referrals’ from the AHCRP, providing this CVD population with additional valuable support in achieving their rehabilitation goals.



9.20 - 9.30Improvements In The Mediterannean Diet Score And Fruit, Vegetable And Fish Consumption In A Diverse Ethnic Group Attending The Imperial Cardiovascular Health Programme

Ellis SM, Bovill-Taylor C, Szymula E, Pattni C and Connolly SB

Imperial College Healthcare NHS Trust, Imperial College London

Introduction

Cardiovascular disease (CVD) is a significant cause of premature mortality in the UK particularly in black and minority ethnic groups. Lifestyle modification including healthy food choices is important in CVD prevention but evidence for successful strategies in BMEG is lacking. The Imperial Cardiovascular Health programme includes individualised dietary assessment as well as a tailored dietary advice that is culturally appropriate to a multi-ethnic population. Here we describe the dietary changes in cardiovascular patients taking part in the programme stratified by ethnicity.

Methods

The programme is delivered over 12 weeks by a multi-disciplinary team, and includes dietetic 1:1 and group education on a Mediterranean diet pattern. All patients have their diet assessed using a diet history and the Mediterranean Diet Score at the start and end of the programme.

Results

Between 2009 and 2015 3,232 patients attended a baseline assessment. The mean age was 63.5 (±10.7) yrs and 63.4% were male. 47.1% attended an attended an end of programme assessment. The patients were stratified into the following ethnic categories; white 66.5% n=801), Asian 15.4% (n=186), Black 10.3% (n=124), Arab 7.8% (n=94). Table 1 shows the dietary changes by end of programme in each principle ethnic group.

Conclusion

The Imperial Cardiovascular Health programme is an effective programme that significantly increases adherence to a Mediterranean diet pattern in an ethnically diverse population in the UK. These changes should help reduce their cardiovascular risk particularly if maintained in the longer term.


Moderated Posters

M1. Specialist Monitoring And Intervention – An Important Mechanism For Cardiac Rehabilitation Effectiveness

L Neubeck, S Randall, SHM Lin, J Smith, AM Clark, R Gallagher

The University of Sydney

M2. Getting On With Life’: Smokers’ Experiences Of Posttraumatic Growth Following A Myocardial Infarction

Dr. S. Morgan, Dr. J. Moses, Dr. L. Speck.

Abertawe Bro Morgannwg University Health Board

M3. A Cross-Sectional Study Investigating The Relationship Between Adherence To A Mediterranean Dietary Pattern And Nutritional Knowledge Among Cardiac Rehabilitation Patients

Jones1, D. Fox1, A. Morrin1, I. Todd2, F, Divers2, J. McCluskey1. 1 School of Health Sciences, Dietetics Nutrition and Biological Sciences Division, Queen Margaret University, Edinburgh, UK.

2 NHS Lothian

M4. Cardiovascular Disease Prevention And Recovery Programme

GM List, BJ Barnard, G Letcher and Z Black

Mediclinic Vergelegen, Busamed and Helderberg Village

M5. Factors Associated With Cardiovascular Re-Hospitalisations Following Phase III Cardiac Rehabilitation

C. Lykidis 1, M. Adams 1, J. Buckley 2, J.P. Fisher 3, J. Burke 1.1. Cardiac Rehabilitation and Prevention Services, Sandwell and West Birmingham Hospitals NHS Trust. 2. Department of Clinical Sciences and Nutrition, University of Chester 3. School of Sport and Exercise Sciences, University of Birmingham


Thursday Posters

T1. Home-Based Versus Centre-Based Cardiac Rehabilitation: Cochrane Systematic Review And Meta-Analysis

SA Buckingham1, RS Taylor2,3, K Jolly4, A Zawada5, SG Dean2,3, A Cowie6, RJ Norton7, HM Dalal1,2

1 Department of Research, Development & Innovation, Royal Cornwall, Hospitals NHS Trust, Truro, UK 2 Institute of Health Research, University of Exeter Medical School, South Cloisters, St. Luke’s Campus, Heavitree Road, Exeter, UK EX1 2LJ

3 National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula

4 Institute for Applied Health Research, University of Birmingham, Birmingham, UK5 Agency for Health Technology Assessment and Tariff System, Warsaw, Poland6 Cardiac Rehabilitation, University Hospital Ayr, Ayr, UK7 Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK

T2. Mind The Gap: Supporting Psychological Well Being With The New Digital Heart Manual Revascularisation Edition

C Deighan, J Elliott, L Michalova, L Taylor, Heart Manual NHS Lothian

T3. Applying Evidence From Cardiac Rehabilitation To Support Cancer Survivorship: The Cancer Manual

C Deighan, L Taylor, Heart Manual NHS Lothian and NHS Taunton & Somerset Cancer team

T4. A Unique Approach To Individualised Exercise Prescription Within Cardiac Rehabilitation

A.Darby, N. Graham, A. Swan.Cardiac Rehabilitation, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust

T5. The Beneficial Use Of Exercise Tolerance Testing Within Cardiovascular Rehabilitation

C. Mullin and J. HannayWirral Community NHS Foundation Trust

T6. Evaluation Of A Bariatric Tier 3 Service Supported By Exercise Physiologists Within A Cardiovascular Rehabilitation Setting

J. Hannay and C. MullinWirral Community NHS Foundation Trust


Thursday Posters

T7. Mediterranean Diet Adherence And Blood Lipids In A Very High Cardiovascular Risk Group

T.J. Butler, K. Gabrysch, H.L. Tudball, A. Bhatkande and A. Woodall, Department of Clinical Sciences and Nutrition, University of Chester, Chester, CH1 4BJ, UK

T8. Audit Of Discharge Summaries–A Simple Tool To Improve Survival In Heart Failure

A.H. A. Khan¹, A. A. Khan², K. Ranjadayalan¹ ³ ¹ Barts and The London School of Medicine and Dentistry, Queen Mary University of London² Tameside General Hospital, Ashton-Under-Lyne³ Newham University Hospital, Barts Health NHS Trust


Friday Posters

F1. High Intensity Interval Training Versus Moderate Intensity Steady State Training In UK Cardiac Rehabilitation Programmes (HIIT Or MISS UK): Study Protocol For A Multi-Centre Randomised Controlled Trial And Economic Evaluation

G. McGregor1,2, S. Nichols3, T. Hamborg4, L. Bryning5, R. Tudor-Edwards5, D. Markland6, J. Mercer2, S. Birkett3, S. Ennis1,2, R. Powell1, B. Begg2,7, M. Haykowsky8, P. Banerjee1,9, L. Ingle3, R. Shave2 and K. Backx2

1 Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK2 Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK3 Department of Sport, Health & Exercise Science, University of Hull, Hull, UK4 Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK5 Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK6 School of Sport, Health & Exercise Sciences, Bangor University, Bangor, UK7 Aneurin Bevan University Health Board, Gwent, Wales, UK8 College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA9 School of Health & Life Sciences, Coventry University, Coventry, UK

F2. A Systematic Literature Review Of The Cost-Effectiveness Of Cardiac Rehabilitation Interventions

GE Shields1, D Buck1, A Wells2, P Doherty3, T Heagerty4 and LM Davies1

1 Centre for Health Economics, University of Manchester2 Department of Clinical Psychology, Manchester Royal Infirmary3 Department of Health Sciences, University of York4 Institute of Cardiovascular Sciences, University of Manchester

F3. Clinical And Psychological Outcomes Of An Angina Management Programme

D Tinson, S Swartzman, K Lang, S Spense, I Todd Cardiac Rehabilitation Lothian Nhs

F4. Relaxation Therapy Is Perceived As “Beneficial” For Isle Of Man Patients’ Attending A Cardiac Rehabilitation Programme

Alanach-Mead J, Occupational Therapist and Callow M, Registered NurseDepartment of Health and Social Care, IOM Government.

F5. Improving Anticoagulation Management In Patients With Atrial Fibriliation

Dr Raymond Chong, Dr Abhishek Chitnis, Dr Husam Benfadel, and Dr Aftab Khan,Department of Cardiology, Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-Under-Lyne, OL6 9RW


Friday Posters

F6. Prevention Of Weight Gain In Smoking Cessation Through An Integrated Cardiovascular Health Programme

Stokes E, Tuson C, Matthews M, Bartlett K, Cabuago J, Mackay T, Siwicka T, Harris N, Edwards JE, Connolly SBImperial Cardiovascular Health programme, Imperial College Healthcare NHS Trust

F7. Nurse Led Diagnostic Testing for Peripheral Arterial Disease – All Cardiovascular Rehabilitation Patients Screened and ABPI Performed if Appropriate

S. Faulkner, L. Lunt, J. Simpson, R. KavanaghKnowsley Community Cardiovascular Service, Liverpool Heart and Chest NHS Foundation Trust, England

F8. Primary Prevention ICD/CRT Screening for patients attending Cardiovascular Rehabilitation

S. Faulkner, L. Lunt, L. Devitt, J. Simpson, R. KavanaghKnowsley Community Cardiovascular Service, Liverpool Heart and Chest NHS Foundation Trust, England

F9. Heart Failure Cardiac Rehabilitation: To Evaluate The Use Of Pedometers In Improving Cardiac Rehabilitation Outcomes, Such As Quality Of Life And The Six Minute Walk Test, In Patients With Heart Failure

J Finlay, M Harris, K Brown, S Francombe, J Austin. Aneurin Bevan University Health Board, Nhs Wales

F10. Randomised Pilot Study Into The Effects Of Low-Frequency Electrical Muscle Stimulation In Advanced Heart Failure Patients: Feasibility Of A Large Scale Trial

S. Ennis, G. McGregor, S. Singh, T. Hamborg, and P. BanerjeeUniversity Hospitals Coventry and Warwickshire NHS trust

F11. What Psychological Needs Do Emotionally Distressed Cardiac Rehabilitation Patients Think They Have, And How Well Do They Think That Cardiac Rehabilitation Addresses Them? A Qualitative Study

R McPhillips, P Salmon, A Wells, P FisherManchester Mental Health and Social Care Trust


Going ‘live’ at conference...

BACPR Research NetworkThe purpose of the BACPR research network is to help share details of

cardiovascular evaluative projects and research. The network acts as a communicative hub, allowing researchers to upload details of their projects, and view

the work of others. Non-members can submit studies to the network, and view the list of those added, however only BACPR members have full access to all project details and the

ability to contact project leads.

Although not designed to provide an in-depth, detailed account (e.g. abstract or full report) of all studies, the network has a ‘related publications’ section which allows project leads to provide links to publications or presentations that have resulted from their work.

All studies remain ‘live’ within the network for five years, and details of all projects accepted for poster or oral presentation at the BACPR annual conference will be added to the network every year.

Visit www.bacpr.com now for details of all of this year’s abstracts...!


Calling all Programmes.....!

Global Survey of Cardiac Rehabilitation:

Availability and Characteristics of

Programs study

We have previously circulated information on this study survey. If you would still like to add your programme’s data to this innovative international project, please follow the link:

https://redcap2.mayo.edu/redcap/surveys/?s=sX8TG6

If you access the survey and don’t have time to complete, please note that there is an option to ‘save’ at the bottom of every page. We’ll be kept up to date on the survey results through our membership of the ICCPR and will hope to share results with you in the future.

www.globalcardiacrehab.com


Notes


Future Diary Dates

BACPR Exercise Professionals Group Spring Study DayFriday 19th May 2017Aston University Birmingham

Please register your interest by email to [email protected] and visit the EPG page of the BACPR website for further details

BCS Annual Conference5- 7 June 2017Manchester Central, Manchester

Visit www.bcs.com/conference for online registration and programme


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Email: [email protected]

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bacpr annual conference 2016 · stands, posters & country update stations [exhibitor area]...

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