Preventive Cardiology

Transcription

1 Preventive Cardiology 21 Volume The Preventive Cardiology and Rehabilitation Prevention Outpatient Visits 7,876 Program helps patients identify traditional and Phase I Rehab 9,932 emerging nontraditional cardiovascular risk Phase II Rehab 4,39 factors through a comprehensive assessment. Phase III Rehab 3,44 Patients receive an individualized treatment plan that includes collaboration with referring physicians. After the initial consultation, patients usually return for a limited number of visits before returning to their primary care or referring physician. LDL Levels Among Statin-Tolerant Adults Both primary and secondary prevention patients seen in the Prevention Clinic showed marked reductions in LDL levels. Data represent patients who were seen at baseline and had at least two follow-up visits. Primary Prevention, Statin-Tolerant Adults (N = 1,253) 2 The Women s Cardiovascular Center provides comprehensive cardiovascular medical care to women, with a focus on prevention. The Center has special expertise in preventive cardiology, coronary artery disease, vascular disease, heart failure, pregnancy and heart disease, as well as valve disease. The Center continues to attract a significant percentage of new patients to Cleveland Clinic for their care. In 21, we treated patients from all over the world and more than 31 states mg/dl Baseline mg/dl 2nd Follow-up Secondary Prevention, Statin-Tolerant Adults (N = 537) mg/dl Baseline 63 mg/dl 2nd Follow-up 7 Outcomes 21

2 LDL Levels Among Statin-Intolerant Adults Patients who could not tolerate statins and were referred to the Prevention Clinic still experienced LDL reductions. Data represent patients with documented statin intolerance who had at least two follow-up visits in the Prevention Clinic. Primary Prevention, Statin-Intolerant Adults (N = 492) mg/dl Baseline mg/dl 2nd Follow-up Secondary Prevention, Statin-Intolerant Adults (N = 359) mg/dl Baseline mg/dl 2nd Follow-up Sydell and Arnold Miller Family Heart & Vascular Institute 71

3 Preventive Cardiology (continued) Exercise Prescription To help patients start an exercise program, they may request an Exercise Prescription. Preventive Cardiology staff members determine the patient s level of fitness and design a customized exercise program that details the needed frequency, intensity, type and length of exercise sessions. Volume N = Since 24, the number of patients who have received exercise prescriptions has increased 6%. Groups of 6 to 8 patients with similar health concerns can take part in a Shared Medical Appointment that includes a dietitian and nurse practitioner. Patients benefit from a single visit that addresses multiple needs and provides personalized dietary counseling and group interaction and support. The Weigh to a Healthy Heart The Weigh to a Healthy Heart is a comprehensive 12-week weight loss program designed to help prevent cardiovascular disease. Patients benefit from an interdisciplinary approach that includes dietitians, physicians, exercise physiologists and behavioral counselors. The program includes private nutrition sessions, an exercise prescription, group exercise classes, lipid and fasting sugar testing, weekly group support sessions and help creating a grocery list. Median Weight Loss over 12 Weeks pounds pounds 72 Outcomes 21

4 Pediatric Preventive Cardiology and Metabolic Clinic (N = 258*) 21 The Pediatric Cardiology and Metabolic Clinic offers patients under Age 18 with cardiometabolic dyslipidemia or genetic dyslipidemia a comprehensive assessment, lifestyle management advice, medication and monitoring. Data are for patients with genetic or cardiometabolic dyslipidemia who had at least two followup visits in 21. Value (mg/dl) Baseline 2nd Follow-up LDL HDL Triglycerides Total Cholesterol *Pediatric patients with genetic dyslipidemia To help track the activity level of some patients in the Pediatric Cardiology and Metabolic Clinic, we attach a blinded pedometer to the patient s shoe. Data is collected during normal routines, and the pedometer is mailed back to us. The information, including number of steps, distance, intensity, duration, and calories spent during activity, is reviewed at follow-up visits and used to identify opportunities for behavior change and to suggest lifestyle modifications. Image property of A&D Medical. Data representation subject to change. Sydell and Arnold Miller Family Heart & Vascular Institute 73

5 Preventive Cardiology (continued) Cardiac Rehabilitation Outcomes measured in the Cardiac Rehabilitation Program include those related to functional capacity, quality of life, blood pressure and program compliance. Improvement in Exercise Capacity by Exercise Stress Test (N = 335) 21 METs Change = The metabolic equivalent of task (MET) is the ratio of the working metabolic rate to the resting metabolic rate. Each 1-MET increase in functional capacity reduces the risk of mortality by 8 to 12 percent. The average predicted reduction in mortality for patients in the program from improvement in functional capacity (METs) was approximately 15 percent. Data represent all cardiac rehab patients with both entry and exit visits in Entry METs Exit METs Improvement in Quality of Life Assessment (N = 791*) 21 SF36 Score Cardiac Rehab Entry Cardiac Rehab Exit Physical Summary Score Mental Summary Score Quality of life (QOL) is measured using the Short Form, 36-item (SF36) Health Status Survey, which is a validated QOL measure to track overall wellness of patients in cardiac rehabilitation. Patients who completed the program experienced improved physical and emotional QOL. *21 data from the Short Form, 36- Item (SF36) Health Status Survey. SF36 is a validated quality of life measure used to track overall wellness in cardiac rehabilitation. 74 Outcomes 21

6 Cardiac Rehabilitation Improvement in Systolic Blood Pressure (SBP) (N = 335) 21 Blood Pressures (mm HG) Cardiac Rehabilitation Improvement in Weight (N = 335) 21 Pounds Entry SBP 27 Entry Weight Change = -14 mm HG 126 Exit SBP Change = 6 lbs 21 Exit Weight A total of 78 percent of patients who completed the Cardiac Rehabilitation Program achieved normal blood pressure (<14/<9 mmhg). The average improvement was -14 mmhg. Data represent all cardiac rehab patients with both entry and exit visits in 21. The average weight loss among patients completing the Cardiac Rehabilitation Program was 6 pounds. Data represent all cardiac rehab patients with both entry and exit visits in 21. Patients with cardiovascular disease frequently have anxiety and depression, which negatively impact their recovery, motivation, quality of life and prognosis. The Cardiovascular Behavioral Health Clinic assesses and treats patients with a variety of cardiovascular diseases, including patients who have coronary artery bypass (CABG) and valve surgery, those with congestive heart failure, hypertrophic obstructive cardiomyopathy, arrhythmia, fibromuscular dysplasia, ventricular assist devices (VADs), and those at risk for developing cardiovascular disease. A staff psychiatrist evaluates patients and develops an appropriate treatment plan. 75 Sydell and Arnold Miller Family Heart & Vascular Institute 75