Background: Community based cardiac rehabilitation programs are considered best practice post-cardiac event. Uptake of exercise cardiac rehabilitation is generally low across New Zealand, with Tangata whenua and Pacific Islanders most at risk of non-participation. Delivering guideline based exercise programs in the community is also problematic with difficulty in providing sufficient staff with relevant qualifications to support patients. Methods: The cardiac rehabiliation team at the Auckland District Health Board developed a community-based exercise program in the Mt Albert region in partnership with physiotherapists and the local Whanau Ora provider, Te Hononga in July 2015. The program comprises an 8-week program, with twice weekly exercise sessions for 1 hour that is able to accommodate 12 patients per session. The aim was to increase participation of Maori and to incorporate the holistic whanau ora approach to cardiac rehabilitation. Results: Te Hononga have worked alongside ADHB staff to supervise the prescribed exercise program and have helped facilitate Maori and Pacific patients to attend the program. The Te Hononga MDT of Registered Nurses, Lifestyle coaches and social workers in addition provide support through Phase 2 and 3 to Maori and Pacific clients to achieve long-term adherence to lifestyle changes. As this program is run in a community gym, this has empowered patients to continue with exercise in a public gym beyond the phase 2 program. Conclusion: This innovate holistic approach to exercise has facilitated the transition from phase 2 to long-term management of risk factors for heart disease for the most vulnerable patients. The partnership with the Whanau Ora provider has provided a more patient centric approach to the program.
Background
Early cardiac rehabilitation (CR) nurse follow up clinics 2- 3 weeks post hospital discharge have been instituted at our Hospital for all patients with established coronary artery disease to improve patient engagement and adherence. In the last 2 years these clinics have increased in attendance rates and patient complexity. These now have medical supervision, allowing for active management of patients. Patients are seen multiple times to maximize evidence based treatments by the same nurse. Risk factors are addressed in these clinics and patients are invited into cardiac rehabilitation education classes and individualized prescribed exercise programmes.
Purpose
To assess rates of adherence and intervention in CR nurse clinics.
Methods
The CR team at our Hospital has prospectively recorded rates of adherence and interventions at Nurse Specialist clinics over a 12 month period.
Results
718 (94%) patients attended CR nurse clinics following discharge. Of these 413 (57%) patients had an intervention in clinic: up titration was 38% for RAAS/beta blocker, 11% for statin and 18% for antianginal and BP medication. A further 21% were referred for further investigations or treatments including admission to hospital. 48% (Standard deviation 11%) attended a cardiac rehabilitation programme in addition to these 1 hour clinics.
Interventions in clinic
Conclusion
Nurse Specialist clinics with medical supervision that are scheduled early post discharge provide a safety net for patients who are discharged following short hospital stays. They also lead to increased prescription of secondary prevention medication and ensure patients have appropriate investigations and referrals. These clinics have resulted in change in practice with routine doctor follow up clinics now cancelled. Long term follow-up for patients is now rationalized and has freed up doctor clinics for more complex patients. Early and intensive engagement with patients is also associated with higher uptake of cardiac rehabilitation programs.
Acknowledgement/Funding
None
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