Cardiac Rehabilitation and Secondary Prevention National Heart Foundation of Australia

Transcription

1 Cardiac Rehabilitation and Secondary Prevention

2 Heart Foundation - What do we do? Leading charity aiming to reduce death and disability from coronary heart disease. Produce information for the community and health professionals. Work with decision makers to improve services. Through donations, fund leading research in Australia.

3 Cardiovascular Disease On average one Australian dies as a result of CVD every 12 mintues. 1 CVD has the highest level of health-care expenditure of any disease group. Between and , health-care expenditure allocated to CVD increased by 48% from $5,207 million to $7,717 million, representing 12% of the total expenditure budget. 1. Australian Bureau of Statistics. Causes of Death 2013 (3303.0). March Australian Institute of Health and Welfare Health-care expenditure on cardiovascular diseases Cat no. CVD 65. Canberra: AIHW.

4 Cardiovascular Disease in Australia Around half of all coronary events occur in those people who have had a prior event People with existing CHD Have an increased risk of sudden death Have an increased risk of developing Chronic Heart Failure 1. Australian Bureau of Statistics. Causes of Death 2009 (3303.0). May 2011

5 What is Cardiac / Cardiovascular Rehabilitation and Secondary Prevention? all measures used to help people with heart disease return to an active and satisfying life and to prevent the recurrence of cardiac events..it involves medical care, control of biomedical and behavioural risk factors, psychosocial care, education and support for self-management These are all similar terms which are often interchanged. Cardiac Rehabilitation is often time-limited, a component of the Secondary Prevention continuum that is lifelong. It doesn t matter so much what you call it as long as the patient gets referred to it!

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7 Cardiac Rehabilitation reduces mortality accelerates recovery improves clinical outcomes (improved chol, BP) improves behavioural outcomes (ex tolerance, smoking cessation) reduces repeat cardiovascular events and hospital readmissions strengthens adherence to medication and enhances mental health and QoL Briffa T et al. An integrated and coordinated approach to preventing disease events in Australia. Policy statement from the Australian Cardiovascular Health and Rehabilitation Association, Med J Aust:190:683-6.

8 The evidence Systematic reviews Heran et al (2011) - improved overall and CV mortality, hospital readmission rates, QoL Anderson et al. (2016) exercise based CR significantly reduced hospital admission and cardiovascular mortality van Halewijn et al. (2017) found no effect on all-cause mortality, but reduction in CV mortality by 58%. ( ) Powell et al. (2018) re-examined the evidence yr 2000 onwards - no sig difference in all- cause or CV mortality and only borderline statistical difference in hospital admissions

9 The evidence RCT West et al trial of 1813 patients in the UK no significant differences in mortality, cardiac events or level of PA. Cohort reduced all-cause mortality and hospital re-ad rates following CR widely reported in large population studies (de Vries et al. 2015; Dunlay et al. 2014; Pouche et al. 2016; Kureshi, 2016; Goel;2018, Lee, 2016; Junger et al, 2010; Hammil et al. 2010; Jimmenez- Navarro et al. 2017).

10 Different approaches to CR To address poor participation and access. Reviews - positive outcomes for telephone support, video conferencing, home based programs, or internet based programs. Clark et al., 2015; Dalal et al. 2010; Huang et al., 2015; Kotb et al., RCT s demonstrating similar benefits of alternative models of CR. Jolly et al., 2009; Varnfield et al., 2014; Cossette et al., 2012.

11 Lack of referrals to CR Only about 30% of patients are referred to cardiac rehabilitation 1. 65% is the gold standard target set by the UK National Health Service which meets international best practice 1 71% of patients would go to cardiac rehabilitation if a health professional discussed it with them before leaving hospital 2 1. NHS Improvement Heart. Making the case for cardiac rehabilitation: modelling potential impact on readmissions, Heart Foundation. Heart Attack Survivor Survey, 2015.

12 Australian evidence: 27% acute coronary syndrome patients received optimal in-hospital preventive care. Optimal care means receiving lifestyle advice, referral to rehabilitation and prescription of secondary prevention drugs. STEMI, NSTEMI, PCI/CABG during admission or history of hypertension were more likely to receive optimal preventive care. Older patients (>70yrs) or admitted to private hospital = less likely to receive optimal care. Redfern J, Hyun K, Chew DP, Astley C, Chow C, Aliprandi-Costa B, Howell T, Carr B, Lintern K, Ranasinghe I, Nallaiah K, Turnbull F, Ferry C, Hammett C, Ellis CJ, French J, Brieger D and Briffa T. Heart 2014;01-8.

13 Costs Of the 54,000 heart attacks that occur each year, each one costs around $30,000 in healthcare Cardiac rehabilitation program costs the health system an average $885 per person to attend. De Gruyter, Elaine., Ford, G., Stavreski B. (2016). Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services A Cost Benefit Analysis. Heart, Lung and Circulation, 25, ,

14 Cost benefits in WA If attendance rates increased from 30% to 65 the benefits in WA after 5 years would be: $28.4 million in savings in healthcare costs $48 million in social and economic benefits Reduction in 1,700 hospital admissions for heart attacks. De Gruyter, Elaine., Ford, G., Stavreski B. (2016). Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services A Cost Benefit Analysis. Heart, Lung and Circulation, 25, ,

15 What does Cardiac Rehab involve? Traditional programs Centre based multi disciplinary team Exercise groups x2/wk for 6-8/52 Individual support Group education sessions Medications Symptom Mx HD and Risk factors Dietician healthy diet Stress Mx Adjustment and recovery

16 What does Cardiac Rehab involve? CR is part of usual care Encourage self management Patient may not show interest until weeks, months, years after initial event

17 What does Cardiac Rehab involve? Alternative models of CR Telephone coaching or follow-up Internet / phone app based programs Telehealth Case management / modular approach Home based programs

18 Who s responsibility is CR and SP? Everyone! Hospital Tertiary Secondary Primary Care GP Practice Nurses Allied Health Community support Walking groups Local pharmacist Private practitioners Psychologist Physiotherapist Dietician Diabetes educator

19 Where ever you work you have the opportunity to help start the ball rolling on the journey of recovery and lifestyle change.

20 Teaching on the run Opportunistic education Engaging the family Use different approaches and resources Repeating messages in different ways Brief intervention motivational interviewing

21 What policy do we have? ealth.wa.gov.au/docs/1405_ CRSP_Pathway_Principles _WA.pdf

22 CRSP Pathway Principles CR can occur in many different settings

23 2018 National Heart F oundation of Australia

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25 cations/hf.cardiac_rehab_factsheet_webhr.pdf

26 ACRA-WA Peak body Networking

27 org.au/cardiac-servicesdirectory

28 Practical resources

29 The go to resource

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37 Tips on how to communicate with patients inc difficult topics eg SEX plus practical resources and tools

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41 Online modules MHML allow approx. 4-6hrs HF 3hrs

42 Sign up for the Heart Health Network Newsletter (before next VC!)

43 Heart Foundation HELPLINE Qualified Health Professionals: supporting you & your patients Phone:

44 Ordering resources: Website or Heart Foundation Helpline (by or phone)

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50 CALD & Low literacy

51 2018 Nati onal Heart Foundation of Australia

52 Guidelines

53 Range of CR posters. Please contact us in WA

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56 St Vincent's heart health ( Includes videos: CR overview, exercise, quitting smoking, RF, returning to activities, medications

57 Teams track activity, fruit & veg Individual healthy lifestyle program

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59 Heart Foundation Walking App: Prime Minister s One million steps challenge

60 Health app (iphone) Activity, mindfulness, nutrition, sleep C25k Couch to 5km in 9 weeks

61 FoodSwitch Bupa, The George Institute traffic-light labelling system or the new Health Star Rating system: Saltswitch, glutenswitch, fatswitch, sugarswitch Myfitness Pal Calorie counter and diet tracker, assesses exercise to determine needs

62 My Quitbuddy

63 Cardihab CSIRO & Qu Health Cost $$$ Scientifically validated Digital Cardiac Rehabilitation (DCR) solution uses smartphone apps and web portals to give clinicians the ability to deliver more convenient, flexible and engaging CR services to patients Far more likely to participate than those who had to travel to an outpatient clinic (80% vs 60%). More likely to adhere to the rules of the program (94% vs 68%) and see it through to completion (80% vs 48%).

64 Heart Maps

65 What other useful tools or resources would you recommend? Evaluation forms: feedback & future topics please

66 Thank you Please contact us at:

67 Secondary Prevention of Heart Disease, Thursday 9th August