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The Heart Failure Clinical Programme and its impact on Cardiac Rehabilitation Karen Cradock, B. Physio, MSc. Therapy Lead.

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Presentation on theme: "The Heart Failure Clinical Programme and its impact on Cardiac Rehabilitation Karen Cradock, B. Physio, MSc. Therapy Lead."— Presentation transcript:

1 The Heart Failure Clinical Programme and its impact on Cardiac Rehabilitation Karen Cradock, B. Physio, MSc. Therapy Lead

2 2 IHF 2001 The scale of Heart Failure in Ireland ~ 300,000 people with LV Dysfunction; more than 100,000 with HF

3 The Heart Failure Pyramid HF patients with a history of admission Symptomatic HF in the community Asymptomatic Ventricular dysfunction 15,000 – Sick HF 85,000 – Stable HF 250,000 – Impending HF


5 Heart Failure: Problems and Solutions Life Cycle Ideal : Life Cycle with Heart Failure: 40 yrs 85 yrs Hospitalisations First Diagnosis 75 yrs 40 yrs At Risk PreventionCommunity MxHospital

6 Heart Failure Solution Life Cycle of Heart Failure in 2011: 75 yrs40 yrs Hospitalisations 40 yrs 76 yrs Life Cycle with Heart Failure Programme:


8 Objectives Access – Every patient with symptoms of heart failure is diagnosed correctly and without delay Quality – Every patient with heart failure is managed within a structured programme – Implement targeted programme to prevent heart failure Cost – Reduce recurrent admissions by 1,000 with additional impact on de novo admissions – Reduce length of stay saving 20,000 hospital days per year

9 IMPLEMENTATION OF PROGRAMME Heart Failure Clinical Lead 2 WTE Heart Failure Nurses in hospitals accepting acute admissions (1.5 WTE HFN in hospitals with mainly non acute admissions and providing out patient services) Administrative support available Adequate clinical space to see patients available Structures in place for timely access to BNP and echocardiography Access to therapy services

10 Inpatient2-3 visitsSelf care management Week 1 Week 2Clinic visitECG, BNP, Bloods, QoL Measures Week 3 Week 4 Week 5 Week 6Clinic visitEducation – review of medications Week 7 Week 8 Week 9 Week 10 Week 11Tel Week 12Clinic visitECHO, bloods, HADs, enrolled in rehabilitation programme Note: Access to Monday to Friday 5 day per week clinic for unscheduled visit

11 Active National Programmes St. Vincents University Hospital Tallaght Hospital St. James Hospital Mater Hospital Beaumont Hospital Our Lady of Lourdes Hospital, Drogheda Wexford General Hospital Galway University Hospital Portiuncula Hospital, Ballinasloe

12 Key performance indicators Key performance indicatorTarget 2012 Metric August 2012 Rate of readmission for heart failure within 3 months following discharge from hospital 27%6.3% Median Length of Stay for patients admitted with a principal diagnosis of ADHF 7.0 days 8.0 days Percentage of patients with ADHF who are seen by the Heart Failure Clinical Lead during their hospital stay >65%92.3% N = 427*

13 Intervention AdherenceOutcomeFollow up Courtney 2009RCT (blinded) Intervention n=58 Control n= 64 Mean age 78.8±6.8 years Muscle strengthening, balance training, walking, muscle stretching. Assessed by PT. HV by Nurse 48 hours post DC weekly follow up calls X 4 weeks, monthly telephone follow up X 5 months 53% of intervention arm training at 6 months 24% less admissions to ED in the intervention arm 42.3% less emergency GP visits in the intervention arm 21 readmissions in the intervention with 49 in the control 7 months Wierzchowlecki 2006 RCT Intervention n=80 Control n =80 HFU visit day 14, and at 1,3,6 and 12 months Access to cardiologist, HF CNS, Psychologist, Physio Control; Primary physician Reduced hospital admissions by 37% Reduced hospital readmissions with HF by 48% Mean duration of hospitalisation I= 9.3 days C=12.5days 1 year Austin 2008n=112 SC=55 CR= 57 Cardiac rehabilitation (twice weekly) 8 week MDT programme. This was followed by a 16 week community based exercise class V standard HF follow up Number of inpatient days was 50% lower in CR group I=4.1days C=8.4days Survival was 32 months in CR group V 23 months in SC group. 5 years

14 Davidson 2010n=105 RCT12 week once per week tailored MDT programme All cause hospitalisation; I = 25 C=35 P< Cardiovascular events; I=24% C=55% Mortality: 79% alive in the usual care V 93% in the intervention arm 5 year follow up Reed 2010 HF Action I = 1159 UC= supervised exercise sessions Hospitalizations I=2297 UC=2332 LOS I= 13.6days UC=15 days Total medical cost I=50,857 dollars UC=56,177 dollars Cost of intervention years

15 Cochrane Review- Exercise based Rehabilitation for Heart Failure Follow upHRQoLSignificance HF- ACTION (2009)30 monthsKCCQP<0.001 Austin (2005)6 monthsMLWHF EQ-5D P<0.0001* P<0.01* 5 yearsMLWHF EQ-5D P<0.001* P=0.12* Bellardinelli (1999)15months 19 months MLWHFP<0.001

16 Model AHeart Failure team manage the service Model BIntegration of cardiac rehabilitation and heart failure services


18 Training Heart Failure Nursing Professional Certificate UCD On-going course – intake annually (FETAC level 9) Advanced Skills Training for Physiotherapists in Heart Failure Commenced in September 2012 – 6 months training (Aspiring to FETAC level 9 ) Pharmacy Training ProgrammeUndergoing development Foundation CourseIn the discussion phase (Possibly e-learning)


20 Units planning for implementation of the National Heart Failure Programme (Sept 2012) Connolly Hospital Cavan/Monaghan Hospital Group Mid Western Regional Hospital, Limerick Sligo General Hospital

21 Impact of Programme on Cardiac Rehabilitation All current programme sites have cardiac rehabilitation programmes- likely to be referred- will they be included in the group sessions? Can cardiac rehabilitation become integral part of this care structure?

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