Cardiac rehabilitation thinking broadly
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Cardiac Rehabilitation : Thinking Broadly. Professor Geoffrey Tofler 19 th September 2007. Background. Rehabilitation - a key ingredient for optimal management of the patient with coronary disease and heart failure.

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Cardiac Rehabilitation : Thinking Broadly

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Cardiac rehabilitation thinking broadly

Cardiac Rehabilitation:Thinking Broadly

Professor Geoffrey Tofler19th September 2007


Cardiac rehabilitation thinking broadly

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


Cardiac rehabilitation thinking broadly

Stents as an Alternative to Lytic Therapy

in Acute Myocardial Infarction


Cardiac rehabilitation thinking broadly

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


Cardiac rehabilitation thinking broadly

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)


Cardiac rehabilitation thinking broadly

ACS/PTCA Admission

Seen by CR

Referred to APAC

Seen at home within 24 hrs post discharge

Cardiac CNS

Physio

OT

S/W

Pharmacist

Cardiac Rehab

GP

Cardiologist


Cardiac rehabilitation thinking broadly

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


Cardiac rehabilitation thinking broadly

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Ann Sullivan, Robyn Cleary, Geraldine Gillies,

Susan Hales, Ingrid Pryde, Vanessa Baker


Cardiac rehabilitation thinking broadly

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

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

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)


Cardiac rehabilitation thinking broadly

Summary

  • Patient not service focussed

  • Work together across different settings and disease stages

  • Community colleagues

  • Cardiac Rehab link with medical teams

  • Involve other specialties

  • Optimal use of resources


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