cardiac rehabilitation : thinking broadly professor geoffrey tofler 19 th september 2007
TRANSCRIPT
Background
• Rehabilitation - a key ingredient for optimal management of the patient with coronary disease and heart failure.
• Good hospital community linkage - goal of keeping patients well in the community.
• Standards of care - Disease Framework
• Models of care may differ
NSAHS primary angioplasty program
• Approximately 3,900 patients treated
• Average bed stay 3.2 days versus 7.2 days (lytic)
• Cost saving to NSAH $11,000,000 over 10 years.
• 200 patients “Field Triage” from 2004
• Mortality 2% at 30 days
Northern Sydney Cardiac Rehab and APAC Collaboration
• Provide seamless continuum of care - hospital to home
• Facilitate early and safe discharge from the acute setting
• Reduce anxiety levels
• Improve uptake to cardiac rehab program
• Access a wider population by introduction of an alternative home-based model
•(Helen Tsakonis, Ann Kirkness, Vanessa Baker)
ACS/PTCA AdmissionACS/PTCA Admission
Seen by CRSeen by CR
Referred to APACReferred to APAC
Seen at home within 24 hrs post dischargeSeen at home within 24 hrs post discharge
Cardiac CNSCardiac CNS PhysioPhysio OTOT S/WS/W PharmacistPharmacist
Cardiac RehabCardiac RehabGPGP CardiologistCardiologist
Results of Collaboration
• 85% of patients referred by CR seen by APAC (n=319)
• Positive trend in CR attendance (50 to 60%)
• Lowered anxiety levels
• Overall very positive feedback
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Ann Sullivan, Robyn Cleary, Geraldine Gillies,Susan Hales, Ingrid Pryde, Vanessa Baker
MACARF BREAKDOWN OF ENROLMENTS NOV 2004-OCT 2006
0
50
100
150
200
250
HOME P
ROGRAM
EDU
NSHNS
APAC
REFERRED CRHOS
NH OA
REHAB
NU
MB
ER
OF
PA
TIE
NT
S
2004-2005
2005-2006
NURSE INTERVENTIONS 2004-2006
28
15
38
44
20
3
5
41
54
17
25
100
37
50
79
25
0
10
57
34
37
27
0 20 40 60 80 100 120
OTHER PHONE CALL
SPECIALIST PHONE CALL
GP PHONE CALL
SERVICES
NSHNS
APAC
CARDIAC REHAB
HOME EXERCISE PROGRAM
OTHER MEDICATION ISSUES
CARDIAC MEDICATION ISSUES
EXTRA FRUSEMIDE
NUMBER OF INTERVENTIONS
2005-2006
2004-2005
Assuming addressing cardiac med issues and extra Lasix prevented an admission, 64 x 8 x $600 = $331,000 saved 2005/6
Use of Cardiac Rehab Facilities at Ryde Hospital – Kellie Roach
• Cardiac Rehab sessions, includes high risk diabetic patients – 2 sessions /week
• Heart Failure – 3 consecutive sessions (Susan Hales)
• Pulmonary Rehab – 2/week (Sally Watts)
• Joint replacement / orthopaedic (Steven Spinatti)
Collaborative Weight Management for Coronary & Type 2 Diabetics - Ann Kirkness
• 70% Cardiac Rehab patients are overweight or obese, and 68% remain so at completion.
• Obesity - risk factor for both CAD and Type 2 Diabetes
• CR and Diabetic Education Centre to share existing resources and more structured approach to weight.
• 33 patients since Sept 2006
• Mean 3.4kg weight loss at 4 months (33%≥5%)
• Increase physical activity (72%, 4month; 56%, 8month)