Related Experiment Videos
Achieving national service framework standards for cardiac rehabilitation and secondary prevention
Hasnain M Dalal1, Philip H Evans
1Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ. hmdalal@doctors.net.uk
Insights
Integrated care significantly improved cardiac rehabilitation and secondary prevention for myocardial infarction survivors. Nurse-led primary care clinics achieved national targets for optimal patient outcomes.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Background:
- Integrated care for myocardial infarction (MI) survivors is often inadequate, with low rates of cardiac rehabilitation and suboptimal secondary prevention.
- Existing care models fail to meet the needs of post-MI patients, leading to poorer long-term health outcomes.
- A gap exists in seamless transitions of care from hospital to primary care for MI survivors.
Purpose of the Study:
- To evaluate an integrated care model for patients surviving acute myocardial infarction.
- To assess the impact of a novel cardiac rehabilitation program on secondary prevention targets.
- To determine the feasibility of achieving national service framework targets through primary care integration.
Main Methods:
- A 12-month audit of 106 acute myocardial infarction survivors within a primary care trust and district general hospital setting.
- Implementation of a novel, integrated cardiac rehabilitation system led by a cardiac liaison nurse.
- Patients were offered a choice of home-based (Heart Manual) or hospital-based rehabilitation, with primary care practices maintaining a coronary heart disease register.
Main Results:
- All 106 eligible patients were offered cardiac rehabilitation and enrolled in primary care registers.
- Completion rates for cardiac rehabilitation were 87% for home-based and 49% for hospital-based programs.
- Significant improvements were observed in secondary prevention targets, with serum cholesterol <5.0 mmol/l increasing from 28% to 75% at 12 months; optimal care achieved for antiplatelet therapy, statins, and smoking cessation.
Conclusions:
- Integrating home and hospital-based cardiac rehabilitation services with primary care secondary prevention clinics can achieve national targets for MI survivors.
- Nurse-led clinics in primary care are effective in facilitating long-term structured care and optimizing secondary prevention.
- The developed integrated model demonstrates a successful strategy for improving post-MI patient care and outcomes.
Problem:
Integrated care for patients who survive a myocardial infarction is lacking. Many patients are not offered cardiac rehabilitation, and secondary prevention is not optimal.
Design:
12 month audit of 106 patients who survived an acute myocardial infarction.
Background And Setting:
Carrick Primary Care Trust in Cornwall (population 98 500) and one district general hospital.
Key Measures For Improvement:
Proportion of patients who complete a cardiac rehabilitation programme after a myocardial infarction. Proportion of patients with optimal secondary prevention, as measured by smoking status, body mass index, cholesterol <5.0 mmol/l, and blood pressure <140/85 mm Hg.
Strategies For Change:
We set up a novel, integrated, and seamless system for cardiac rehabilitation. We employed a cardiac liaison nurse to identify and assess in hospital all patients with suspected acute myocardial infarction. The nurse offered patients the choice of home based rehabilitation with the Heart Manual or hospital based rehabilitation. The nurse gave discharge details to the patient's general practice; these were to be included on a practice based register of coronary heart disease.
Effects Of Change:
All 106 eligible patients were offered cardiac rehabilitation and were included in a practice based register of coronary heart disease to facilitate long term follow up in primary care. 47 (44%) patients chose home based rehabilitation with the Heart Manual, and 41 (87%) of these completed the programme; 35 (33%) patients chose hospital based rehabilitation, and 17 (49%) of these completed the programme. The numbers of patients achieving secondary prevention targets improved significantly: those with serum cholesterol <5.0 mmol/l at discharge increased from 28% at baseline to 75% at 12 months. Optimal care (at least 80-90% uptake of an intervention) was seen with antiplatelet and statin treatments and with smoking cessation. Significantly more patients were prescribed statins at follow up than at baseline (77/106 v 80/91, P=0.005).
Lessons Learnt:
National service framework targets for cardiac rehabilitation and secondary prevention can be achieved in patients who survive a myocardial infarction by integrating rehabilitation services (home and hospital) with secondary prevention clinics in primary care. Nurse led clinics in primary care facilitate long term structured care and optimal secondary prevention.