Cardiac Rehab UK - British Cardiovascular Society · pilot sites working at trying ... ‘generic...
Transcript of Cardiac Rehab UK - British Cardiovascular Society · pilot sites working at trying ... ‘generic...
Cardiac Rehab UKIssue 11 – May 2008
Updated highlights from around the
UK include:
WestminsterPatients and practitioners pledge support –
Over 5,000 campaigners have signed the
petition in favour of universal cardiac
rehabilitation (CR) provision. Many letters
have been sent to MPs asking for their
support and many MPs have passed on the
campaign message to the Department of
Health.This kind of pressure can only help
in bringing forward action on CR.
Westminster Parliamentary lobby - Over
50 patients and CR practitioners
descended on Westminster to lobby their
local MPs about the need for more quality
CR provision. This gave a considerable
additional boost to the profile of CR in
Westminster, with over a dozen
parliamentary questions since tabled to
ministers. Continued on page 2
Update on the Campaign for Cardiac Rehabilitation2008 is a vital year for the National Campaign for Cardiac Rehabilitation and great progress
is already being made. We need your help to turn this into real results for heart patients.
The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk
Inside this issue� Laughing matters!
� Asian Cardiac Rehabilitation class
� Gardening for hearts and minds
The BACR has had the development of a
CR tariff on its radar for some time, but
until recently we never really knew the
scale of the task ahead.
The launch of the BACR Minimum
Standards and Core Components set the
scene for the start of negotiations with the
Department of Health (DH),
and in collaboration with
Professor Bob Lewin (NACR
team) and Mike Yates (DH),
we have managed to push
for cardiac rehabilitation (CR)
to become a priority for
future commissioning.
This has led to the
development of a DH task
group aimed at defining the tariff and also
promoting CR within the existing
commissioning framework. The process is
far from complete but the team is
optimistic about making the tariff a reality.
The next 6 months are crucial in ensuring
that the evidence for CR and cost of CR
are collated and agreed by
the DH group. We have five
pilot sites working at trying
to define the operational
aspects of the present
service provision, which
includes a coal-face
estimate of costs. The CR
tariff is being held back due
to the DH aim to have a
‘generic rehabilitation tariff ’. We have
recently, after considerable debate, won
the right to put a case for a stand alone
CR tariff.
This is far from guaranteed but we are
putting together a strong case and if
successful the group will prepare for the
next phase which is to work with the
Payment by Results (PbR) team and push
for a 2009 CR tariff. The CR tariff is closer
now than ever before and the BACR,
NACR, BHF and DH-PbR will collectively do
all they can to bring this about in 2009.
Professor Patrick Doherty, Chair of
Rehabilitation,York St. John University
[email protected] Patrick Doherty
The editorial team would like to welcome Anu Mukherjee to the team as the new
project lead and editor. Anu has recently joined the BHF and we look forward to
working with her in the future as I know she will be a real asset to the development
and production of the newsletter.
Diane Card – BHF Heart Health Co-ordinator and Content manager
for the Cardiac Rehab UK newsletter
CR Tariff
Cardiac Rehab UK May 2008
2 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk
Meetings with Minister and key
opposition MPs – A meeting was held
with Ann Keen MP, the Minister for
Cardiac Services. She was highly
supportive of the aims of the campaign,
but restated that it is up to PCTs to
deliver quality CR services. Briefings have
been held with the front bench health
teams of the Conservatives and Liberal
Democrats, who were highly receptive to
the strength of the evidence in favour of
CR. Our aim will be to get specific CR
commitments into party manifestos.
CR and the tariff system – Discussions
have taken place with the Department of
Health about including CR in the English
NHS tariff system. This is an extremely
important development as it could
massively improve the flow of funding to
CR programmes and make it more likely
that Primary Care Trusts in England will
provide quality CR.
New NICE CR commissioning toolkit –
The National Institute for Clinical
Excellence (NICE) will be launching a
cardiac rehab commissioning toolkit later
this month. That will benchmark
standards and encourage the
commissioning of quality CR programmes
by PCTs. This will provide a hook for
campaigners to draw their local PCT’s
attention to this unequivocal support
for CR.
ScotlandOn 25th March, BHF Scotland and Chest
Heart and Stroke Scotland held a reception
at the Scottish Parliament bringing together
campaigners, health professionals and
cardiac rehab patients from every corner of
the country.This reception was the focal
point for the campaign and will allow
Members of the Scottish Parliament the
chance to hear first hand what is going on
in cardiac rehabilitation. Cabinet Secretary
for Health and Wellbeing, Nicola Sturgeon,
was the keynote speaker at the event.The
reception was also the premiere for the first
showing of the Scottish Campaign vodcast,
featuring people from the Stirling Healthy
Hearts Group talking about the benefits of
cardiac rehab and how it has helped them
to live with heart disease.
Success in WalesOver 60 heart patients and health
professionals attended a cross-party
Assembly reception in Cardiff Bay at the
beginning of March – a successful event
with 24 Assembly Members, and the Health
Minister present.This event was a joint
organisational effort by the BHF in Wales
and the All Wales Cardiac Rehabilitation
Working Group as part of the ongoing
campaign in Wales. 2,000 people have
signed our petition and ministers have
faced numerous questions in the Assembly.
First Minister Rhodri Morgan has recognised
the importance of CR for heart patients (of
whom he is one).
In January 2008, a meeting was held with
Health Minister Edwina Hart. She then
announced £2m of interim funding for CR
programmes in Wales threatened by a
funding shortfall.This is a fantastic victory
for campaigners and should secure the
future of some vital programmes.
Next stepsOver the coming weeks and months there
will be new actions for campaigners to take
in support of cardiac rehabilitation as we
turn national support into local action.
Please continue to visit the campaign web
page at bhf.org.uk/cardiacrehab to get
involved. For further information on the
campaign please contact Josh Bayly, BHF
Campaigns Officer on 020 7725 0688 or
email [email protected]
Ruairi O’Connor, BHF Deputy Head of Policy
and Public Affairs
Mike Knapton and Edwina Hart
The 7th York Cardiac Care Conference in
April 2007, the launch of the National
Campaign for Cardiac Rehabilitation in
July 2007, and the opportunity to present
the situation and required solution in the
‘Shaping the Future in Cardiology’
symposium last October, led us to survey
the Cardiac Networks for their work plans
in cardiac rehabilitation.
Cardiac Networks are ideally placed to co-
ordinate service improvement across their
health communities.The West Midlands’
Standards for Cardiac Rehabilitation were
developed following the NSF to facilitate
audit and inform commissioning.The first
gap analysis informed allocation of the
original Patient Choice Revascularisation
pathway monies designated for
rehabilitation within the region. We have
led an annual revision of the standards,
and audited against them across The Black
Country Cardiac Network to reveal gaps in
service requiring commissioning. Last year,
the Health Care Commission Health Check
encouraged Trusts to assist the National
Audit of Cardiac Rehabilitation (NACR).
A 16 part questionnaire was developed
and distributed jointly by the Black
Country Cardiac Network and the Heart
Improvement Programme.Twenty nine of
the 30 Cardiac Networks sent the
questionnaire by electronic mail in July
2007, and efficiently completed responses
for provisional analysis by September
Cardiac Networks must tackle the inequity in Cardiac Rehabilitation
Cardiac Rehab UK
The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk 3
Did you hear the one about the heart
patient who was prescribed a special
diet of laughter and humour…he spent
six weeks eating heart-e-jokes? NOT the
best heart joke in the world though if it
caused you even the slightest bit of mirth
you have just taken a dose of laughter
medicine.
Laughter, and an active sense of humour,
is increasingly considered to be a creative
healing technique and recent studies
have shown that it can help protect
against heart attacks. Cardiologists at the
University of Maryland Medical Centre in
Baltimore believe that laughter may help
prevent heart disease and they found that
people with heart disease were 40% less
likely to laugh in a variety of situations
compared to people of the same age
without heart disease. 1
The old saying that 'laughter is the best
medicine’, appears to be true when it
comes to protecting your heart, says
Michael Miller, M.D., Director of the Centre
for Preventive Cardiology at the University
of Maryland Medical Centre. Dr. Miller says
"We don't know yet why laughing protects
the heart, but we know that mental stress is
associated with impairment of the
endothelium, the protective barrier lining
our blood vessels.This can cause a series of
inflammatory reactions that lead to fat and
cholesterol build-up in the coronary arteries
and ultimately to a heart attack.” 2
My own personal journey as a
‘laughologist’ started seven years ago after
graduating from university and becoming
a stand-up comedienne. At university I
studied the connection between arts and
healthcare and having read the book Dr.
Patch Adams – about a pioneer of
humour and arts in healthcare – I became
fascinated with the physiological and
psychological effects of laughter and
humour and was lucky enough to train
with Patch himself.
I have used humour and laughter as a
comedienne to help create different
emotional responses and have linked this
to research into cognitive behaviour.
I realised that thought patterns could be
broken down into a process which others
can adapt and learn for their coping
strategies as well as to improve their skills
of awareness, introspection and
evaluation. This is what I call laughology –
a new pattern of thinking that allows
individuals to look at challenges and
problems in life with a greater sense of
perspective and to gain control over their
emotions.
During the last decade more hospitals in
parts of the world have become
convinced of the therapeutic power of
humour. In the USA, humour based
approaches in hospitals have included
‘humour carts’ containing funny
videotapes, cartoons, games and props.3
Laughology is currently working with
health practitioners, applying cognitive
techniques to improve the health of both
patients and staff. It is about using these
techniques to allow people to cope with
life’s stresses and anxieties in a positive
manner, deploying humour to break
thought patterns where anxiety,
depression and stress can otherwise lead
to negative behaviours and ill health...
terrible heart-e-jokes permitting, of course.
Stephanie Davies, Creative Director
www.laughology.co.uk
Cardiac Rehabilitation Service Manager1 University of Maryland medical centre news release.
www.umn.edu/news/releases/laughter.htm
2 University of Maryland medical centre news release.
www.umn.edu/news/releases/laughter.htm
3 The Humour Cart http://www.jesthealth.com/
art18jnj.html New York hospital humour co-ordinator
http://www.viahealth.org/body_departments.cfm?id
=1221
Laughing matters!
2007, to inform the ‘Shaping the Future of
Cardiology’ perspective in October.The full
results are to be presented at the British
Cardiovascular Society’s Annual Scientific
Conference in June 2008 in Manchester.
Early appreciation of the data has been
reassuring in that almost all Networks now
have cardiac rehabilitation work stream
meetings, most are following defined
standards (usually BACR), and two-thirds
have a designated Cardiologist to lead.The
same proportion have also received
BHF/NOF Cardiac Rehabilitation/
Heart Failure service funding grants.
Whilst eventual commitment to the NACR
audit is expressed by nearly all, only a
minority has so far contributed data from
across their Networks. Home based
options remain sparse at present, and
overall meeting of NSF and NICE standards
is still a minority achievement. Robust
commissioning mechanisms for cardiac
rehabilitation exist in well below half of
Networks, but 10% have revisited access to
revascularisation pathway monies with the
introduction of primary PCI.
An especial pride should be the particular
public and patient involvement (PPI) in the
majority of Cardiac Networks, and the
specific encouragement to improve
cardiac rehabilitation services in half of
Networks by their PPI approach.This
operational survey has supported Cardiac
Networks in developing their cardiac
rehabilitation work plans by sharing
practice experience, and the finding of
commitment by both professionals and
patients.The commissioning challenge
must be met and won to reduce the
persistent inequities of service.
For further information contact:
Dr. Jane Flint, Black Country Cardiac Network
Linda Binder, Heart Improvement Programme
“Years ago my dad had an allotment,
and when I was a boy I would help him
out. Now, years later, and following my
cardiac setbacks, I’ve started gardening
at a cardiac allotment project. I really
enjoy being out in the fresh air, having a
go, and getting to feel more confident
and fit. I also get to reap the rewards of
the allotment when the plants grow –
taking things home to eat – it’s great!”John is just one from a growing band of
people with heart problems who have
rediscovered gardening as a healthy and
absorbing activity that helps them get
their life back.
Thrive, the national charity that promotes
the advantages of gardening for everyone
with a disability, is encouraging more
people to try gardening as part of their
rehabilitation.
Of course, gardening has been used as a
therapy, or as an adjunct to therapy and
rehabilitation, in the treatment of disease
for centuries. But more than that, gardening
brings together physical exercise, fresh air,
healthy eating and new friendships.
Research has shown that increased
physical activity is associated with a lower
risk of cardiovascular and metabolic
diseases (USDHHS, 1996), and that the
introduction of horticulture as an integral
component of the cardiac rehabilitation
agenda may have significant psychosocial
benefits for participants.
The National Service Framework for
coronary heart disease (NSF CHD 2000),
plus the new National Stroke Strategy
(published in December 2007), provide
models to support the achievement in the
reduction of morbidity and mortality, as
well as providing help to service providers
to judge the quality of their services and
plan for the improvements needed.
In a report of the Chief Medical Officer
(Department of Health, 2004a) it
recommends 30 minutes of moderate
intensity physical activity on five or more
days of the week, and notes that the
scientific evidence for the health benefits
of physical activity are compelling.
Gardening can offer people a form of
rehabilitation that:-
� may already be familiar
� can be achieved at home – even in a
high-rise flat
� is accessible and affordable
� can be small-scale (a window box) or
more ambitious (an allotment)
� offers daily exercise with a purpose and
a bonus!
Thrive’s pocketbook ‘Just 30! Gardening for
hearts and minds’ is a step-by-step guide of
gardening activities for people who have
heart problems or have had a stroke.
Funded through the Department of Health,
the guide is being distributed across
rehabilitation units in England during its
launch in May 2008. Fully illustrated, it
guides you through a series of progressive
practical garden activities which can be
done at home, and are suited to improving
specific common problems such as
strength and mobility.The guide also
includes personal stories to inspire others,
contacts for further information, tool
information plus lots more.
A series of ‘Professional Day Workshops’
can be on offered for rehabilitation
professionals and carers, supported by a
dedicated website.
For more details contact Cath Rickhuss
[email protected] / Tel: 0118 988 5688 /
www.thrive.org.uk
Gardening for Hearts and Minds
Cardiac Rehab UK May 2008
4 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk
The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk 5
Cardiac Rehab UK
19 and 20 October 2007, Alton,Hampshire
Course Tutors: Jenni Jones, AnnieHolden and Lesley Simpson
This BACR course is of great benefit to all
healthcare professionals working in the
area of cardiac rehabilitation and wishing
to develop their practice, or very
experienced individuals just wishing to
update their knowledge and skills.
The supporting materials are clear, easy to
understand and very user friendly. The
precourse reading serves as an appetiser
to the course, heightening the desire for
further knowledge, and the lectures
expand on it seamlessly. The course
manual contains detailed information of
all the topics covered in the course, and
used in conjunction with the slide
presentation booklet serves as an
invaluable resource for post course
consolidation and future reference.
The course content is delivered by the
lecturers using basic, easily digestible
language and making it accessible to all
regardless of previous experience. Jenni
Jones’ sessions on anatomy and
physiology, as a result, were not only
interesting, but fascinating.The overview
of different formulas for monitoring
exercise intensity, and the use of different
assessment tools turned a confusing issue
into a simple tool kit. The group sessions
on adapting exercise for special patient
populations gave nuggets of priceless
information whilst provoking further
discussions between delegates.The
practical sessions ended the days well,
providing fun, informative examples of
exercise circuits and warm up sessions.
The two days were well structured and
provided suitably timed breaks with
refreshments. Individual requests were
catered for where possible and if not, it
was not for the want of trying.
On completing the course I felt I walked
away with a whole set of resources that I
hadn’t possessed beforehand, plus plenty
of ideas on improving my service. Despite
having some knowledge of the topics
covered by the course before attending,
I hadn’t fully understood how to use it or
apply it appropriately to my practice. As a
nurse running a home based programme,
I had previously felt the area of exercise
prescription was purely the domain of the
physiotherapist.The course clearly
demonstrates how all healthcare
professionals can work together to achieve
the best outcomes for patients.
Suzanne Wood, Community Cardiac
Rehabilitation Nurse for Suffolk PCT
Course Review: BACR Introduction to exercise for healthprofessionals working with cardiac patients
CR professionals and nurses working with
heart failure (HF) patients formed a special
interest group in 2006 to work in
association with BACR and BSH to improve
rehabilitation services and the link
between CR professionals (BACR members)
and HF specialists (BSH members).
Positive developments1. Excellent collaboration and joint
working between BACR and BSH at
Council and Board level. Increased
profile of HF rehabilitation at national
meetings and professional associations.
2. Education opportunities – there are
now two new one day training
courses, for nurses and ex-professionals
run by ACPICR, in association with
BACR. Very popular and well evaluated.
� ‘Physical activity and exercise
advice for HF patients’: ACPICR in
association with BACR Information
contact for series of one day
courses run for nurses and exercise
professionals
Melanie.Reardon@southportandor
mskirk.nhs.uk and
3. Regional Networking – there are now a
number of regional HF rehab groups, eg
� The All Wales HF group meet
quarterly to discuss areas of HF
care and share good practice.The
group was initially instrumental in
developing a Quality Framework
for HF in Wales document. Offers
peer support/encouragement to all
interested professionals. Further
information please contact Dr
Jacky Austin
A newsletter will be posted on the BACR
(www.bcs.com/bacr) and BSH
(www.bsh.org.uk) websites to update
members. We hope to develop this into an
interactive communication forum
providing peer support shared practice.
Fiona Lough, Cardiovascular Health and
Rehabilitation, University College Hospital
London
Heart failure rehabilitation interest groupupdate to BACR Council
NHS Improvement Programme
From 1 April, the NHS Heart Improvement
Programme will join three other service
improvement teams to become NHS
Improvement.
NHS Improvement is the largest
improvement programme in England,
working with clinical networks and NHS
organisations to transform, deliver and
sustain improvements across the entire
pathway of care in cardiac, stroke, cancer
and diagnostic services.
Bringing together over eight years
practical service improvement experience
from the Heart Improvement Programme
(HIP), Cancer Services Collaborative
‘Improvement Partnership’ (CSCIP) and
Diagnostics Service Improvement (DSI)
Programme, NHS Improvement aims to
continue to test and support practical
implementation of service redesign
methods and share the learning. NHS
Improvement demonstrates a ‘how to’
approach to achieve sustainable effective
pathways and systems to improve the
efficiency and quality of NHS Service.
The existing good work of the HIP, CSCIP
and DSI will continue under the umbrella
of NHS Improvement, along with new
work implementing the national Stroke
Strategy. The Stroke Improvement
Programme will help to establish stroke
care networks, and lead work to improve
stroke services across England. This will
involve co-ordinating national
workstreams that mirror the priorities in
the strategy to help accelerate the
implementation of improvements both
within and across stroke services.
www.improvement.nhs.uk
0116 222 5184
Buckinghamshire New University
students publish early
PhD students within the Cardiovascular
Health Research Group at Buckinghamshire
New University are expected to publish
their findings in advance of submitting
their theses or shortly afterwards. Research
in cardiovascular health is often a coherent
series of empirical studies, each of which
can be written up on completion. Lynette
Hodges (PhD student 2001 – 2004)
published her work on supervised
rehabilitation in peripheral vascular disease
in 2006 and on erectile dysfunction prior to
myocardial infarction (MI) in 2007. Gavin
Sandercock (PhD student 2001 – 2004)
published his work on heart rate variability
instrumentation in 2004 and Samantha
Breen (MPhil 2004 – 2008) published her
work on cardiac rehabilitation programmes
in England in 2006. More recently, Djordje
Jakovljevic published in 2008 on
methodological comparisons to measure
cardiac output, David Nunan published in
2008 on the poor agreement of two
metabolic systems and Gay Donovan
presented a poster in Cardiff at the BACR
Conference on the physiological outcomes
of using a left ventricular assist device.
The University supports students to present
at international conferences and the above
have given oral communications in Vienna,
Cairo, Nashville, Dublin Copenhagen,
Jyvaskyla, Belgrade and Boston.
Two recent recruits to the Cardiovascular
Health Research Group include Johana
Nayoan who is currently collecting
psychological indices on post MI patients
in the Asian Heart Institute in Mumbai and
Nonsi Mathe who will be examining
coronary risk indices in rural and urban
populations in Zimbabwe.
Professor David Brodie
Healthy meals, healthy heart
A new cook book containing
over 60 easy to prepare
Asian recipes is now
available. Healthy meals,
healthy heart demonstrates
how you can still enjoy
biryani, your favourite curries
and even samosas, just by making some
small changes to the ingredients you use
and the way you cook them.
Stock code G362 Suggested donation £5
Keep you heart healthy
Heart information series number 25
A new booklet has been
added to the Heart
information series, Keep your
heart healthy. This booklet
aims to explain how, by
making changes to your
lifestyle, you can look after
your heart and reduce your risk of
developing certain heart conditions, such as
coronary heart disease or having a stroke.
Stock code HIS25
Kids’ and schools’ catalogue
Our brand new Kids’
and schools’
catalogue details all
the resources we
have available for
3 – 18 year olds. Stock code G66
Heart HelpLine card
For information and support on anything
heart – related call our Heart HelpLine on
0845 70 80 70. Order the HelpLine card with
a fridge magnet. Stock code M54
100 Voices
To get the real story of how it feels to live
with coronary heart disease today, we
interviewed 100 heart patients. 100 voices
is a unique glimpse into the lives of people
living with heart disease. Stock code G402
News News News News News News
Cardiac Rehab UK May 2008
6 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk
How to order
Call the order line on 0870 600 6566,
email [email protected] or visit the
BHF website at bhf.org.uk/publications
BHF Publications
UPDATE
News News News News News News News News News
Help a Heart campaign 2008
This June our Help a Heart campaign is
dedicated to raising money to invest in life
saving heart research and we urgently need
volunteers to take part in House to House
collections in their area.
House to House collections are a great way
to help the BHF. It’s a wonderful way of
making friends, getting fit and meeting the
local community. It involves dropping off
and collecting back cash collection
envelopes in a local area. Collectors can
always do the collection with a friend or
family member for company.This may be a
good activity for your patients to take part
in and perhaps could even go towards their
30-a-day!
We would really appreciate it if you could
tell your patients about House to House
collections and encourage them to take
part. Volunteers are an essential part of the
Help a Heart Campaign. By knocking on
doors and talking to neighbours, volunteers
help to raise awareness and money.
Margaret Rees’s son, Hugh, died when he
was sixteen years old from heart disease.
Margaret believes that the work carried out
by the British Heart Foundation is important
not only because of the funding provided
to medical research and the support of
doctors and nurses, but also because of the
awareness that the charity raises about the
factors that contribute to heart disease,
such as an unhealthy diet and lifestyle.
And it is for this reason that Margaret values
her role as supporter and volunteer for the
British Heart Foundation in her local
community. Margaret says,‘we believe
absolutely in trying to raise money so that
in the next decade there might be some
new and remarkable treatments to help
people like Hugh.’
If you, or any of your patients are interested
in helping with our House to House
collections or supporting the Campaign,
please can you contact us on 0845 241
0976 or email [email protected].
Congratulations to Len Tate MBE
Len is a heart support group patient from
Ipswich and was awarded an MBE in the
New Years Honours list for services to
health. It was for his involvement in and
association with work at Ipswich hospital,
the local PCT and the local heart
support group.
It is a wonderful achievement for Len to
be recognised for his tireless work in his
local community.
The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk 7
Cardiac Rehab UK
Asian Cardiac Rehabilitation ClassThe Asian community is approximately
50 per cent more likely to suffer from
coronary heart disease with less
favourable outcomes than the majority
of the population.
Dawn Newman-Cooper, the Cardiac
Rehabilitation Co-ordinator at West Kent
Primary Care Trust, launched the Asian
Cardiac Rehabilitation programme (part of
the Heart of Community project) in
September 2007.The PCT is supported by
British Heart Foundation funding in
association with the Big Lottery.
In partnership with the Asian community,
the class started life in the Guru Nanak in
Gravesend as a separate women’s and
men’s class, delivered by an English female
instructor.
Originally perceived barriers were:
� language
� licence for Asian music to be used
� recruitment of patients
� cost effectiveness.
Six months on the classes have evolved
and have moved from the Guru Nanak at
the request of the members to a Church of
England hall for accessibility.
� Classes are of mixed gender so when
self funded they are more affordable
[funded by the BHF grant until
December 2008]
� Members enjoy the English music used
to motivate them in exercise
� The majority of the class are English
speaking or other members translate
simple instructions
� There are 17 members and the class is
growing through word of mouth
among the Asian community,
advertising and GP referrals.
Mrs Sehgal had coronary angioplasty and
stents implanted in 2004 and joined the
Asian Cardiac Rehabilitation class in
September 2007. Since then, she is more
confident to exercise and feels staying
healthy is beneficial for her heart. Mrs
Seghal is the Chairperson of the Asian
Women’s Group in Gravesend.
Naomi Coupland has been a fitness
instructor for five years, specialising in
cardiac rehabilitation for a year.
She runs five cardiac rehabilitation and gym
programmes in the area in addition to the
class exclusively for Asians.“I enjoy working
with people where exercise and healthy
eating is not really part of their lifestyle,”she
says.“The class has only been running six
months but I feel it is very much
appreciated and we are already seeing
small changes such as a reduction in
breathlessness and improvement in
co-ordination.”
Dawn Newman-Cooper
Naomi Coupland
NACR What do the patients think?GM&C is the best overall performer in
England in the National Audit of Cardiac
Rehabilitation (NACR).
The cardiac network takes this opportunity
to praise our cardiac rehabilitation
practitioners over Greater Manchester and
Cheshire, while freely acknowledging we
have a long way to go; not least to do
better by the female gender, our most
elderly and fragile residents, plus the black
and minority ethnic population groups we
wish to serve.What the practitioners
themselves want to feed back about NACR
includes a request for the audit to keep up
with the terminology now in use and to
say thanks for the Quality of Life
questionnaire, which some people find
such a useful aid, they wonder how they
managed without it before! They also like
having access to their own data.
If you visit our website
www.gmccardiacnetwork.nhs.uk you will
see our new network strategy,“Where do
we go from here?” (Cardiac strategy for the
years 2008-2011). Cardiac rehabilitation is
our third priority for action, pipped to the
post by functional imaging (first) and
primary angioplasty (second).
NACR also played its part here.We have
three million people to plan for, and our
network has a higher death and illness rate
for cardiac disease than almost anywhere
else.We have to be informed about what
action we are taking and, in turn, inform
our commissioners.We asked the relevant
clinical advisory group to write the case for
rehabilitation among about 30 other
interventions for prioritisation. So, a third is
very good.
But what do our leading patient
representatives think? Most patient
representatives have experienced cardiac
rehabilitation and patient support groups,
so are rehab’s most insightful allies.We
asked David Houghton and David Geldard,
both members of the network board and
big guns in their own communities of
Bolton and Rochdale, and below is a
summary of their thinking:
� wherever there’s a national audit, there’s
action, so they like the NACR
� how else would you know how strong,
or not, your rehab service is without this
audit? If you’re not doing it, get cracking
� we may have good access to cardiac
rehab in this network. But then again,
we have to. CHD is our major health
problem
� a lot of unsung heroes in support
groups provide services for patients; it’s
a shame not all PCTs look to them as
providers and help fund them
� what the NACR has done is prompt
PCTs in this area to look at rehab; said
PCTs should also look through the eyes
of the patient and then make funding
decisions in a coherent manner through
Phases I to IV
� practitioners put in more time to the job
than can be reasonably expected by
their trusts (and this can be seen in the
results)
� the uptake for heart failure patients
(where there is a service) is poor
� roll on the reaudit – we will have local
roadshows to celebrate successes and
recognise weaknesses
� good quality is accessed by a minority
of patients at present (and if everyone
attended the possible exercise
resources, organisations would have to
increase provision to meet demand)
� it is the lower socio-economic groups
who fare the worst. Hospital-based
rehab can be unnerving, or impossible
for some in need of it: provide more
choices: home, chair-based etc.
We know cardiac rehabilitation’s place in
our cardiac network, we want more,
everywhere, and we know our attitude to it
(menu-based and creative to meet diverse
needs, fix the access issues and please un-
bundle the tariff ).
Our patient representatives want to tell
readers of this article that patients think
they may be “coming to the end”when
they have their heart problem. Rehab lifts
that (especially for the depressed ones). It is
not just a therapy of exercise and
education, but one of companionship,
meeting other people and talking about
your experiences.
In short, we are showing up well in the
audit, but, effectively, NACR suggests we
could be “brilliant” (David Houghton) for
not very much money.
For more information contact Sally Wells at
Cardiac Rehab UK May 2008
8 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk
Cardiac Rehab UK
The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk 9
The Spa at Beckenham in the London
Borough of Bromley, Kent is the home of
a special programme called MyAction.
In June 2007, the MyAction
multidisciplinary team, a cardiac specialist
nurse co-ordinator who is also an
independent nurse prescriber, a dietitian
and a physical activity specialist, set up
their office at the Spa.They started to
recruit patients with coronary heart disease
from the local hospital, as well as
individuals at high risk of developing
cardiovascular disease from general
practice, together with their partners, to a
preventive cardiology programme.
MyAction is the product of EUROACTION
(www.escardio.org/euroaction), a European
demonstration project in preventive
cardiology, but tailored for our NHS.
EUROACTION showed that a nurse led
multidisciplinary family based approach to
lifestyle and risk factor management can
achieve real lifestyle improvements and risk
factor reductions in coronary patients, and
those at high risk of developing
cardiovascular disease compared to the
same groups of patients and families
receiving standard care.
MyAction is the inspiration of Professor
Wood’s cardiovascular team at Imperial
College London, who are now partnering
with Steve Price and his team at the
Bromley Mytime Charitable Leisure Trust.
MyAction brings together the leisure trust
and the PCT in an evolution of the
EUROACTION model. EUROACTION
programmes were set up in hospitals for
coronary patients and their families, and in
general practice centres for individuals at
high multifactorial risk and their families.
Now MyAction has taken it one step
further by bringing these groups together
in one community facility. Unlike hospitals
and general practices, this leisure facility
has an ambiance of wellness. It has a more
encouraging environment and helps
families to adopt a healthy lifestyle where
adults and children can be physically active
and enjoy themselves.
The programme in Beckenham is the first
programme to be set up using this
innovative community model and is
serving as a valuable showcase for
interested Cardiac Networks and PCTs.
The unique features of this novel MyAction
programme are:
� leisure centre location
� co-ordinated by a nurse prescriber
supported by a dedicated dietician and
physical activity specialist/
physiotherapist
� family based
� focussed on lifestyle change
� management of other risk factors: blood
pressure, lipids and glucose
� provides an integrated care pathway for
both coronary patients and those at
high risk of developing the disease, in
the same community facility.
The central co-ordinating team and
Bromley Mytime are looking to partner
with more PCTs and leisure trusts to set up
MyAction programmes around the
country. MyAction is based on the principle
of integrating existing services, which are
commonly run separately, for different
groups of high risk patients. Our new
service promotes unified and
comprehensive preventive care.The
EUROACTION central team will provide
training, a health professional manual, a
database and family educational materials
plus support for the delivery of the
MyAction programme to a high standard
including mentoring and clinical audit.
For further information contact Annie
Holden, Manager of the MyAction
Programme, Bromley
Catriona Jennings, Cardiac Specialist Nurse
on behalf of the EUROACTION team
MyActionan innovative approach and partnership possibility to help manage patients with coronary
heart disease, individuals at high multifactorial risk and their families
My Action Team, Bromley
Training opportunities
10 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk
May 2008
An Introduction to exercise for health professionals working withcardiac patientsThis two-day course aims to explore the physiological mechanisms underpinning the exercise
component of cardiac rehabilitation and apply these principles to design and delivery, using
an evidence-based approach. It has a practical emphasis and aims to assist health
professionals with useful tips and suggestions that can be implemented in future service
developments.
Please contact the individual venues below for application forms and more details:
Cramlington, nr Newcastle. 14 and 15 November 2008
Contact: Coral Hanson [email protected] / Tel: 01670 717 421 / Fax: 01670 590 648
London, University College Hospital, 27 and 28 November 2008
Contact: Lesley Gilbert [email protected] / Tel: 0207 380 9756 / Fax: 0207 380 9951
Cost: £250 to BACR members / £280 to non-BACR members (includes BACR membership)
If you are interested in hosting a “BACR introduction to exercise” course contact
An introduction to psychological issues for health professionalsworking in cardiac rehabilitationThis course aims to explore psychological issues that are relevant to cardiac rehabilitation and,
using an evidence-based approach, apply these principles to the design and delivery of
programmes. It has a practical emphasis and aims to assist health professionals to gain an
understanding of what could be incorporated into future service developments.
The course is open to health professionals working with cardiac patients in either a
primary or secondary health care setting (e.g. physiotherapists; specialist nurses [i.e.
cardiac rehabilitation, heart failure, diabetes]; primary care and community nurses;
occupational therapists etc). Instructors with the BACR Phase IV exercise instructors
qualification working in Phase III may find this course useful as it will develop their
clinical knowledge and understanding further. This course is designed for cardiac
rehabilitation professionals who already have some experience of working in cardiac
rehabilitation settings.
Cost: £250 to BACR members / £280 to non-BACR members
If you are interested in hosting this course please email [email protected]
BACR Phase IV exercise instructor trainingThis course provides specialist training for exercise professionals who want to prescribe and
deliver exercise programmes as part of the overall long-term management of individuals with
heart disease.This course has developed strong links between exercise professionals and
clinical professionals within the field of cardiac rehabilitation to enable a high standard of
care for the individual with heart disease. It is a highly respected course within the fitness
industry and is recognised by the Register of Exercise Professionals (REPs).
The course combines five days of course attendance with practical experience gained
through visiting a local clinically supervised cardiac rehabilitation programme. There is
comprehensive course material and students are required to pass both a written paper
and a case study viva in order to gain this well recognised qualification for exercise
professionals.
Courses are run all over the UK. For all course dates and venues please contact:
[email protected] / Tel: 01252 720640 / www.phaseiv.co.uk
The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk 11
Physical activity and exercise advice for the heart failure patient-nursing professionals study day (in association with BACR)This one-day study day is aimed at nursing professionals with experience of heart failure
patients to increase the awareness of the impact of physical activity and exercise in this
patient group.The day has both a case study and a practical emphasis and aims to assist
health professionals with useful tips and suggestions regarding physical activity and exercise
advice for all NYHA status patients, whether seen in the traditional cardiac rehabilitation
setting or in their own homes.
Belfast City Hospital. 9 May 2008
Maria Mooney [email protected] / Tel: 02890 263 826
Assessing, prescribing and delivering physical activity and exercise forthe heart failure patient - exercise professionals study day (inassociation with BACR) This one-day study day is aimed at physiotherapists and other exercise professionals involved
in the assessment and prescription of physical activity and exercise to heart failure patients.
Physiological mechanisms relating to heart failure will be explored and principles in exercise
prescription applied to enable adaptations in respect to co-morbidity and cardio-assistive
devices, using an evidence-based approach.
Ormskirk Hospital, West Lancashire. 14 June 2008
Melanie Reardon [email protected] / Tel 01695 656268
Wythenshawe Hospital, Manchester. 4 October 2008
Laura Burgess [email protected] / Tel 0161 291 2177
Exercise prescription: new insights and management of the complexpatient (in association with BACR)This course aims to encourage all professionals delivering the exercise component of cardiac
rehabilitation to explore current practice and guidelines. Clinical reasoning skills will be
encouraged through facilitated workshops to enable practitioners to interpret and adapt
evidence in order to manage patients whose status falls outside the recommended guidelines.
The exercise implications and practicalities of the more complex patient groups will be
explored. Consolidation of existing knowledge and further understanding will give confidence
in future practice.
The Octagon, Hull. 28 and 29 November 2008
Nicky Gilchrist [email protected] / Tel: 01482 674539
If you are interested in hosting this course or would like course dates please contact
Cardiac Rehab UKCardiac Rehab UK
Events, courses and conferences Manchester Heart Centre ICD Cardiac
Rehabilitation Study Day
27 January 2008
This course offers all health professionals
involved in the delivery of comprehensive
cardiac rehabilitation the opportunity to
access current evidence for ICD
implantation, knowledge of device
properties and considerations for
subsequent patient management. This
course aims to provide consolidation of
existing knowledge and further
understanding which will give confidence
in future practice.
Lecture topics include:
� criteria for ICD implantation
� implantation and device testing
� support post implantation
� questions commonly asked by ICD
patients
� psychological considerations
� exercise considerations ICD Research.
7 July 2008, Postgraduate Centre,
Manchester Royal Infirmary
Cost: £90.00 (Includes refreshments)
For further information contact: Sharon
Green, [email protected] /
Tel 0161 276 6048.
More events on back page
Cardiac Rehab UK May 2008
This is the official newsletter of the British Heart Foundation (BHF) and the British Association for Cardiac Rehabilitation (BACR).Views or opinions that appear or are expressedin articles and letters by an individual do not necessarily represent those of the BHF or the BACR and neither do the organisations endorse any products or services advertised.BHF and BACR do not accept liability for its contents or for consequences which may result from the use of information or advice given.
M88 0508 © British Heart Foundation 2008. Registered Charity Number 225971.
Events, courses and conferences Continued from previous pages
The Cardiac Rehab UKEditorial TeamContent Managers:
Linda Binder, Intern Director (NHS Heart
Improvement Programme)
Diane Card, Heart Health Co-ordinator
(British Heart Foundation)
Geoff Dorrie, Council Member (British
Association for Cardiac Rehabilitation)
Editor:
Anu Mukherjee, Project Officer,
British Heart Foundation
Cardiac Rehab UK is a free newsletter aimed
at health professionals either working in or
with an interest in cardiac rehabilitation.
To subscribe, submit an article or
contact the editorial team, email
Deadlines for submissions
Issue 12, September 2008, 30 June 08
Access the Newsletter online
The current issue and back copies are
available to download from
bhf.org.uk/publications
The current issue is also available via the
BACR website www.bcs.com
Cardiac and Critical Care
Organisation Cardiology
Therapeutics Conference 2008 19
and 20 September 2008
Central London
Keynote lectures following European
Society of Cardiology (ESC) and American
College of Cardiology (ACC)
Congresses:
� Acute Coronary Syndrome (prepare for
NICE 2009)
� Chronic Heart Failure update on progress
� Myocardial Infarction
� Cardiac Rehabilitation update
� Obesity, Nutrition and Cardiovascular
Disease
� Diabetes as a CV disease
� Update from Cardiovascular Network
� Stroke: New Agenda for Cardiovascular
Units and Networks
� Opportunity to network and share ideas
on Guidelines
� Opportunity to ask questions from
Expert Speakers.
For further information and enquiries
contact: [email protected] or
University of York innovation to
deliver on Prime Minister’s CHD
prevention agenda
The Prime Minister has once again placed
CHD prevention at the heart of the
government’s health care agenda. On the
7 January 2008 Gordon Brown outlined his
vision for preventative care by
emphasising the need for ‘personalised
prevention plans’ to be delivered by
professionals in the primary care setting.
Practitioners working with patients at risk
of CHD or living with CHD need to ensure
they are equipped to build and deliver this
preventative care agenda.
The BHF Care and Educational research
group based at the University of York had
previously identified this need and has
developed an innovative approach to
delivering the required educational
support on a national basis.
CHD Prevention Online is a 14 week
course that is delivered entirely over
the Internet.
The course uses unique video-based
patient dramas to create extremely
realistic practice experience. Practitioners
from all over the country, supported by
expert tutors at the University of York,
work with patients in the virtual
environment to assess patient’s risk of
heart disease, manage CHD risk factors
and implement personal CHD prevention
plans.
The course has been adopted nationally
by the BHF to train their new secondary
prevention nurses.
Three cohorts of practitioners have now
completed the course. They describe it as
an excellent learning experience:
Cardiac rehabilitation nurse: ‘The
availability of resources to use in practice,
the added support of the discussion
rooms and tutor access has made for a
phenomenal learning experience.’
Practice nurse: ‘Personal comments in the
course journals were always positive and
encouraging and kept me motivated.’
Coronary care nurse: ‘The virtual patients
made the learning real. These people will
live with me for a long time.’
If you think this course could benefit your
practice visit
www.york.ac.uk/healthsciences/cardiac
for more details.
Other key dates for your diary:
3-4 October 2008
BACR Conference, York. More details to
follow.