Cardiac Rehabilitation: Strategies Approaching 2020

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1 ACC Banff 2015 Cardiac Rehabilitation: Strategies Approaching 2020 James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Libin Cardiovascular Institute of Alberta Total Cardiology, Calgary

2 Acknowledgements and Disclosures Acknowledgements CHS National CPG Committee Memberships All of you! Disclosures Research Funding: Sanofi National CPG Committee Memberships: Canadian Diabetes Association 2013, 2016 Canadian Cardiac Rehabilitation Cardiac Rehabilitation (Past Chair Editions 1,2,and 3) Canadian Hypertension Education Program ( ) C-CHANGE (Canadian Cardiovascular HArmonization of National Guidelines Endeavour) (Co-Chair) CCS Dyslipidemia 2009, 2012, 2015 CCS Smoking Cessation 2011 CCS Committee on Stable Ischemic Heart Disease CCS Committee on Refractory Angina Physical Activity for Adults 2011 Physical Activity for Persons with Spinal Cord Dysfunction (Chair) 2011

3 Knowing is not enough, we must apply. Willing is not enough, we must do. JW von Goethe

4 If you can't explain it simply, you don't understand it well enough. Albert Einstein

5 Cardiac Rehabilitation Chronic Vascular Disease Care Good Clinical Practice

6 Just the Facts

7 Just the Facts N=5886 Clinical Variables 1. Age 2. Sex 3. Ejection fraction 4. Chronic obstructive pulmonary disease 5. Cerebrovascular disease 6. Elevated creatinine 7. Congestive heart failure 8. Dialysis 9. Hypertension 10. Hyperlipidemia 11. Diabetes mellitus 12. Presence of malignancy 13. Current smoking status 14. Former smoking status 15. Prior myocardial infarction 16. Prior percutaneous coronary intervention 17. Prior coronary artery bypass grafting [CABG] 18. Peripheral vascular disease 19. Liver or gastrointestinal disease 20. Severity of CAD (Duke jeopardy score) 21. Treatment strategy (percutaneous coronary intervention or CABG within 1 year of referral)

8 Just the Facts Increased Aerobic Fitness = Lower Morality Symptomatic Populations N = 5641

9 Just the Facts Heard it all before All you need is S&S

10 Approaching 2020

11 Individualized Care Work with what you have

12 Treatment Target Driven

13 Cardio-Metabolic Fitness Stone JA et al. 2009

14 Warburton et al., CMAJ. 2006;174:

15 Metabolic Fitness ü 1/1000 all ideal HF ü 1/10 5 or 6 HF Ideal Health Behaviours üdiet ü 4-5 veggies daily üphysical Activity/week ü 150 min of moderate to vigorous ünon-smoking übmi < 25s CVD Risk Factors ü BP < 120/80 ü TC < 5.2 ü FBS < 5.5

16 CMF

17 CMF Cardiometabolic Fitness 50/50 60/40 70/30

18 Targeted Populations N=13,158 Green line: CR, no DM Yellow line: CR, DM Blue line: no CR, no DM Red line: no CR, DM

19 Team-Based Care Interdisciplinary Multidisciplinary Transdisciplinary

20 Cost-Effectiveness Care Driver in 2020? Risk Driven

21 Expertise Care Driver in 2020? Gain Sharing

22 Clinical Pathways Care Driver in 2020? KISS Keep it simple and Standardized!!!

23 Clinical Information Systems Care Driver in 2020? Maybe! Single Patient Record

24 Summary Quality Outcomes Clinical Pathways

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone

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