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					Cardiac Rehabilitation:
               Thinking Broadly
Professor Geoffrey Tofler
19th September 2007
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
Stents as an Alternative to Lytic Therapy
     in Acute Myocardial Infarction
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 Admission

               Seen by CR


          Referred to APAC


 Seen at home within 24 hrs post discharge


Cardiac CNS   Physio   OT     S/W   Pharmacist



 GP           Cardiac Rehab     Cardiologist
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
Image only slide




                   IMAGE GOES HERE




              Ann Sullivan, Robyn Cleary, Geraldine Gillies,
              Susan Hales, Ingrid Pryde, Vanessa Baker
                                      MACARF BREAKDOWN OF ENROLMENTS NOV 2004-OCT 2006


                           250



                                                                                                2004-2005
                                                                                                2005-2006
NUMBER OF PATIENTS         200




                           150




                           100




                            50




                              0
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                                                                                       EH
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                                                            E
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                                                         R
                       E
                      M
                     O
                     H
                   NURSE INTERVENTIONS 2004-2006

                                                        27
             EXTRA FRUSEMIDE                           25

                                                              37
                                                                                                  2005-2006
    CARDIAC MEDICATION ISSUES                17
                                                                                                  2004-2005
                                                             34
      OTHER MEDICATION ISSUES                                            54

                                                                             57
      HOME EXERCISE PROGRAM                                       41

                                        10
               CARDIAC REHAB        5

                                0
                        APAC        3

                                                       25
                       NSHNS                      20

                                                                                   79
                    SERVICES                                       44

                                                                        50
               GP PHONE CALL                                  38

                                                              37
        SPECIALIST PHONE CALL                15

                                                                                         100
            OTHER PHONE CALL                            28



                                0            20              40              60   80    100 120
                                        NUMBER OF INTERVENTIONS


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)
 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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posted:8/23/2011
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