Cardiac Rehab UK Issue 15 September 2009

Transcription

1 Cardiac Rehab UK Issue 15 September 2009 What contribution will cardiac rehabilitation services make to the future preventative agenda? The new NHS Health Checks argue that those identified as high risk of developing CVD will require management of risk factors and lifestyle advice. There is therefore, a potentially huge impact on existing cardiac services on the horizon. Increasingly across the country, PCT s and cardiac networks are actively reviewing their cardiac services. These include rehabilitation, examining synergies and differences and best fit practices across cardiac and other long term disease conditions with a view to providing the most cost effective and health efficient services for their communities. Given the expertise available within the CR community in terms of risk management, lifestyle advice and setting objectives, it would seem appropriate that CR teams should consider the potential of extending their services by proactively linking with these reviews. With the increasing focus on long term conditions, aims to help people self manage their own conditions, the growth of world class commissioning (primary and secondary care agenda) and the reduction, in real terms, of NHS economic growth, opportunities exist for greater innovation in cardiac services. In order to ensure the needs of patients from conventional CR pathways and NHS Health Checks are met, CR professionals and commissioners need to consider the impact of these changes on service provision and to ensure that current and future practice is fit for purpose. We are sure that there will already be initial work occurring in some areas, and would like to hear news of this. Equally, some of the points raised above may provoke healthy debate and the editorial team would be grateful to receive your views. Please cardiacrehab@bhf.org.uk The Cardiac Rehab UK editorial team Evaluation declared British Heart Foundation/ BIG cardiac rehabilitation funding a success Cardiac rehabilitation is a Cinderella Service ; the 2008 BHF National Audit of Cardiac Rehabilitation showed that less than 40% of those people who the Government say should be attending cardiac rehabilitation take part. In 2004 the BHF and the Big Lottery Fund (formerly the National Lottery now rebranded BIG) got together to offer pump priming funding to groups wishing to improve their local CR service. Two main aims were specified: firstly, to improve the number of people taking part, in particular by trying to enrol those groups who have traditionally been underrepresented, older people, women and people from ethnic minorities; and secondly, to improve the quality of programmes on offer. Between 2005 and 2006 a total of 4.7 million was dispersed to 36 programmes in pursuit of these aims. The evaluation, a collaboration between the BHF Care and Education Research Group and the Social Policy Research Unit at the University of York, showed that the project succeeded in both of its aims. Around 10,000 more patients participated in CR over the life of project. Most of the programmes have continued with local continued on page 2 HEARTLink participants in East Yorkshire Inside this issue BACR President s outgoing statement Cardiac rehabilitation patients in Wales are given the opportunity to obtain credits for learning The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

2 Cardiac Rehab UK September 2009 Wakefield Cardiac Liaison team funding and, at a conservative estimate, the provision created by the scheme will provide places for at least another 3,000 patients a year, hopefully for many years to come. More than a third of the CR programmes exceeded their initial aim for recruiting new patients; this was despite the project running at a time of great turmoil in the NHS, with staff shortages, the reorganisation of primary care into fewer trusts and a financial crisis that often delayed the appointment of staff. Not surprisingly, we found that the better the initial planning had been, and the more widely people in the local health service had been involved in developing the application, the more likely the programme was to succeed in its aims. Many of the programmes had, as secondary aims, increasing the reach of the programme to those groups less likely to attend CR. Here the picture was more mixed: across all the BHF / BIG programmes, there was no evidence of an increase in the percentage of women, people from ethnic minorities or older patients than in the average UK programme. However, in those applications where the first and main aim was to increase the uptake of people from ethnic minorities, there was significant success. It appears that targeting must be very specific to succeed and we still don t understand enough about how to encourage all women and older people who would benefit from CR. There were also many examples of success with the second aim, to improve quality. More than half the programmes succeeded in meeting their initial quality aims, many of which had seemed very optimistic. Indicators of success included significantly shorter waiting list times, fewer patients dropping out before the programme had finished and better staff to patient ratios, all suggesting that additional funding of CR is required across the country if these significant problems are to be addressed. It is clear that the programme has given CR a welcome boost and one that will provide a very significant legacy of benefit for cardiac patients in the future. The full report, giving the methodology and findings of the evaluation can be found at bhf.org.uk/publications/ view_publication.aspx?ps= Corinna Petre, NACR Project Manager Cbp1@york.ac.uk Related articles from previous CR UK newsletters: May 2007: Service development in Salford; and A Road to recovery programme in Suffolk September 2007: Our Cardiac rehabilitation menu January 2008: New and innovative post of cardiac active lifestyle advisor September 2008: Community based cardiac rehabilitation in Daventry, Northamptonshire January 2009: Developing good partnership working Cardiac rehabilitation patients in Wales are given the opportunity to obtain credits for learning Patients attending cardiac rehabilitation programmes in Wales may have the opportunity to achieve accreditation for the education they receive. Through OCN Cymru, a Welsh Assembly Government (WAG) funded initiative, any organisation that undertakes to become a centre for training will obtain funding from WAG. Several cardiac rehabilitation centres in Wales have applied for this funding and are now able to help patients who choose to obtain OCN credits which may be used towards awards such as Duke of Edinburgh, NVQ s etc, helping them to retrain, access further education and learn new skills. The centres offering this to patients have reported very positive feedback, and patients have valued this opportunity for their learning to be recognised. It is not a compulsory part of any cardiac rehabilitation programme, but is a good demonstration of working with other organisations and providing patients with greater choice and opportunities. Although OCN is a UK wide initiative, it is only WAG funded organisations that will engage with the general public and enable them to use the accumulable credit scheme (only applicable in Wales) to access educational bodies in Wales. Curriculum units have been approved for patient use by the National Leadership and Innovation Agency for Health (NLIAH) curriculum governance panel, and meet QCF standards. Currently there are units available in: Living with angina Recovering from cardiac surgery Cardiac rehabilitation continued on page 3 2 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

3 Cardiac Rehab UK Living with COPD Diabetes education at levels one and two Living with cancer at levels one, two and three Living with stroke Routes to recovery from mental illness (a suite of units). Further units in pain management are currently being developed with one of the Trusts in Wales. Copies of the units, and assessment tracking documents, can be accessed through the website, which is being added to daily. To achieve accreditation, patients need to evidence the assessment criteria in the unit using some or all of the assessment strategies at the end of the unit. These should reflect the level of learning (degree of difficulty) and credit value of the unit (the time it takes to learn). One credit is worth 10 hours of learning. Each unit comes with a prepared assessment tracking sheet which can be downloaded from the website. To access the funding for patient education units please contact the training manager at your nearest OCN Centre. Current OCN centres in Wales include; all further ed colleges, all NHS Trusts, Torfaen LHB, RCT LHB and Powys LHB. For more information on your nearest approved OCN centre, for information about the curriculum and quality assurance or to develop a new centre or units, contact Sue.Saunders@ocnwales.org.uk For information about training contact Natalie.Williams@ocnwales.org.uk Alternatively you can also refer to Reproducibility of the Modified Shuttle Walk Test in Phase IV cardiac rehabilitation clients The BACR recommend the use of Modified Shuttle Walking Test (MSWT) to assess and monitor functional capacity in patients with chronic heart failure and patients who have had undergone cardiovascular surgery or pacemaker insertion (Francis, 2000; Lewis et al. 2001; Sandercock et al. 2007). While the MSWT appears able to assess changes in functional capacity in cardiovascular disease (CVD) patients, only the short term (day to day or up to seven day) reproducibility of the test has been assessed (Fowler et al. 2005; Jolly et al. 2008). Given that cardiac rehabilitation (CR) programmes typically last six to 12 weeks, long term reproducibility is clearly of great importance. The purpose of this study was to examine the long term reproducibility of the MSWT in clinically stable CVD patients. Thirty phase IV CR clients aged 55 to 80 participated in this study. A test-retest design was used. Participants were assessed twice using the MSWT, with a minimum of eight weeks between test administrations. After a standard clinical assessment, participants were required to walk on a gymnasium floor marked by two cones set 0.5 m from either end of a 10 m course. The initial walking speed of 0.5 m s-1 was indicated by an audible signal from a CD player. Walking speed increased by 0.13 m s-1 each minute. Heart rate and rating of perceived exertion (RPE) were recorded at the end of each level. Standard test termination criteria were employed. Reproducibility was assessed using intraclass correlation coefficient and limits of agreement. Pre-exercise systolic blood pressure and recovery time rate decreased from test to retest by 7 mmhg and 1.24 min respectively (p<0.05). There were no significant differences between the two MSWTs in respect of; distance walked, peak heart rate and RPE (p>0.05). The intraclass correlation coefficient for distance walked was R=0.80. The limits of agreement test showed a mean test-retest bias of -7 m with limits of agreement ranging from -203 m to 189 m. The intraclass correlation coefficient results suggested good test-retest reproducibility of the MSWT but this was not confirmed by the limits of agreement test. The limits of agreement showed little systematic bias from test to retest indicating that a practice test is not required in this population over this time period. The limits of agreement were larger than in previous studies (Fowler et al. 2005; Jolly et al. 2008). This is probably due to the longer test-retest duration. We also found changes in resting blood pressure and total time to HR recovery from test to retest in some but not all patients indicating perhaps that the notion of a clinically stable patient may be a misnomer. We took no psychological measures prior to either test so cannot comment these but they may also have had an impact on performance. We conclude that biological variation such as changes in symptoms, frequency of exercise training, and motivation may all play a part in creating this large random variation in performance in clinically stable cardiac patients. Further studies to elucidate further physiological and potential psychological factors which may predispose such patients to large variations in performance are warranted. Pepera Garyfallia gpeper@essex.ac.uk University of Essex The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 3

4 Cardiac Rehab UK September 2009 BACR President s outgoing statement Professor Patrick Doherty 2007 to 2009 As BACR President Elect and President, I was fortunate enough to have led the standards working group that culminated in the BACR Standards and Core Components for Cardiac Rehabilitation (2007). This was a significant step in our professional representation, and quality assurance for cardiac rehabilitation (CR) programmes. As a consequence of the standards, we contributed to the NICE CR service commissioning guides for conventional CR and heart failure, which became a catalyst for our longstanding relationship with Payment by Results and NHS Information Centre in tariff development. Recent additions to the standards have included our collaborative work with the Resuscitation Council (UK) where we set minimum standards for the safety of CR exercise based interventions in hospital and community settings. We have also produced a supplement on the staffing requirements for CR programmes, which is a significant shift from profession specific staffing to competency and skills based recommendations. The BACR was confident to make these recommendations because the BACR Education Office, in association with specialist sub groups, has made significant progress in developing and delivering training courses to enhance the expertise, skills and competences that underpin CR. The BACR, alongside the BHF and supported by the NACR team, has been heavily involved in campaigning to secure better funding streams for CR, and with the recent development of the HRG4 acute CR tariff (Phase I) we have reason to celebrate. Unfinished business remains, and future work on the tariff will continue to be supported by the BACR but will also incorporate NHS Improvement (Heart) expertise in securing a full CR tariff. CR is now perceived as a multifaceted service that includes risk factor management and is delivered by a core team of professionals, in unison with patients, to agreed national standards. CR practitioners utilise evidence based approaches to achieve quality outcomes for patients, and should continue to work closely with commissioners and providers to ensure that no one approach is pursued over any other. Patients are finally, following assessment, being given genuine choices including hospital and community based opportunities in groups, and where appropriate, one to one hospital, community or home based interventions. These approaches, coupled with optimal referral (something that has yet to be achieved!), will hopefully lead to greater uptake of services over the next few years. What has become clear is that CR, like many other clinical interventions, needs to adapt to the events and context in which cardiac services are delivered and in that respect change is inevitable. During this period of financial crisis it might be deemed prudent to offer a cheaper version of CR that has a degree of equivalency to existing evidence base versions. However, I would urge that we only commission evidence based CR which we know is extremely effective, value for money and brings substantial improvements in quality of life. The British version of CR is a world leading model and we should make sure it remains so! Although I step down from the President s role in October 2009, I will continue for a further two years on BACR council and I will be working hard with NHS Improvement to drive innovation in the delivery and commissioning for effective CR services. I am very pleased to hand over to Dr John Buckley who will bring a high degree of professionalism to the BACR and will ensure, that as an association, we are informed by, and contribute to, new policy and practice. It has been a privilege working with so many dedicated professionals in the BACR and BCS over the last four years and albeit I d like to thank you all individually, editorial constraints simply allow me to say that without your support and healthy debate we would not have achieved as much as we did. Finally, thank you to the BACR membership for giving me the opportunity to contribute to the future shape of cardiac rehabilitation. Professor Patrick Doherty BACR President Incoming BACR President Dr John Buckley John has been a member of BACR since In this time he s been a regular presenter at conferences and a contributing author, tutor and advisor to many of the BACR education resources. For eight years he served as a founding committee member of the BACR Exercise Professionals Group. John s vision for BACR includes three aims: 1. Enhancing the professional recognition of the association; 2. Augmenting the engagement of members in their association; and 3. Reaching out to the wider group of healthcare professionals now involved in the primary and secondary prevention of cardiovascular disease. 4 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

5 Cardiac Rehab UK Update on the Campaign for Cardiac Rehabilitation On 24 August we launched the latest phase of our campaign to ensure that every eligible heart patient is offered a rehabilitation programme following a heart event. The latest National Audit of Cardiac Rehabilitation has been published, showing that less than half (38%) the patients that should receive cardiac rehabilitation (MI, PCI and CABG patients) do so, and that uptake varies widely across different areas. Additionally, for the first time, it has shown that uptake of cardiac rehabilitation amongst women is less than would be expected. This year, as in previous years, we have seen that not a single programme that returned data was adequately staffed according to the SIGN guidelines, and, despite the tremendous efforts of all cardiac rehabilitation professionals, patients are still missing out in key areas including psychological help, occupational therapy and dietetics. Once more it seems that not only do patients face a lottery in whether they receive cardiac rehabilitation, but also what it looks like if they do. Scotland The Scottish CR campaign, lead by BHF Scotland in partnership with Chest Heart & Stroke Scotland, has recently seen the Scottish Government commit to fulfil our key campaign objective. The new Heart Disease and Stroke Strategy Action Plan commits NHS Boards to allocate resources for the provision of CR for all eligible patients by March This is a huge achievement for the UK campaign, and the Scottish campaign in particular. BHF and CHSS are already in discussions with local health professionals about how to make this happen and what role BHF can play. In addition, the Scottish Campaign has also fulfilled another key pledge by securing agreement from the Scottish Government on the development of a national audit for cardiac rehabilitation for Scotland, which is being carried out by NHS Quality Improvement Scotland. This means the NACR report will not contain Scottish data this year, but when the audit process is completed, information about Scottish provision will be robust and comprehensive for the first time. Wales In Wales only 31% of patients received cardiac rehabilitation, the lowest of the nations included in this year s audit. At the moment the Cardiac Rehabilitation Campaign in Wales sees the dust settling after major NHS reorganisation. By now most of the central planning functions have been decided, but the NHS in Wales remains in a dynamic and fluid state while change is progressed. This is especially true for senior positions outside the Chief Executives of the new Local Health Boards. This has important implications in attempting to engage those involved in delivering, and particularly in commissioning, future services Northern Ireland Over the past few months there has been some movement in cardiac rehabilitation in Northern Ireland. In June 2009, the Cardiovascular Health & Wellbeing Framework was published, setting out 45 standards including a standard on Cardiac Rehabilitation. Standard 25 has taken on board BHF Northern Ireland s call for increased access to cardiac rehabilitation for all. In terms of setting targets on access, new targets will be agreed following the findings of an audit in March BHF Northern Ireland and Northern Ireland Chest Heart & Stroke have come together to campaign on cardiac rehabilitation and are in the process of organising a joint campaign. At present, both charities have arranged a stakeholder engagement event on Cardiac Rehabilitation in August The Northern Ireland Cardiac rehabilitation Campaign will be officially launched at an event in Parliament Buildings on the 13 October England In England, 38% of patients are accessing cardiac rehabilitation, and the targets set out in the 2000 National Service Framework (NSF) for Coronary Heart Disease (CHD) are still miles from being met. The NSF also recommended that cardiac rehabilitation be rolled out to other patients who would benefit from it, for instance patients with heart failure or stable angina. Cardiac rehabilitation is one of the key areas of unfinished business identified from the NSF, and has been highlighted by Destination Destination 2020 is the vision for cardiac and vascular services in England set out by the Cardio & Vascular Coalition, an organisation of over 40 charities and voluntary organisations with an interest in cardiac and vascular care, of which the BHF is a leading member. Across the nations it is time that systems are put in place to ensure all patients who could benefit from cardiac rehabilitation are offered it, understand its benefits and are encouraged to take up this treatment, and do so. We need you to promote cardiac rehabilitation and encourage other health care professionals, including GPs and cardiologists to refer patients and advocate for this life saving treatment. For more information on the findings of the audit and the National Campaign for Cardiac Rehabilitation please visit bhf.org.uk/cardiacrehab The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 5

6 Cardiac Rehab UK September 2009 NHS Improvement national cardiac rehabilitation projects In the summer of 2008, NHS Improvement approached cardiac networks, and their constituent organisations across England, with an offer to support a number of national cardiac rehabilitation projects across England. We were most fortunate in appointing Professor Patrick Doherty as national clinical lead and Dr Jane Flint as national clinical advisor a very strong team which provides clear and relevant leadership to the projects. Following a rigorous submission and review process, initially 13 sites across England were agreed, working on a series of projects aimed to increase the access, equity and uptake of CR services by supporting the implementation of the NICE commissioning guidance. Recently, we have agreed inclusion of three later, but very relevant, submissions. The work is primarily focussed on improving the commissioning of CR with special reference to reducing the inequalities in access. Close working with DH and the BACR and use of the NACR ensure an integrated approach. Service specifications, flexible pathways, redesigned service models, improved referral systems, innovative locations and robust costing and funding arrangements are some of the projected outputs from the projects. One year on the projects are producing results. In this newsletter there is a brief update from two of the project sites and this process will be repeated in further editions of the newsletter. Linda Binder National Improvement Lead Heart NHS Improvement National Priorities project in Harrow setting up vocational rehabilitation Within the North West London Cardiac and Stroke Network, a review of services highlighted that vocational rehabilitation was a missing factor within the package of care across the majority of service providers. A simple pathway has been designed which will allow cardiac rehab teams to identify and refer on any individuals who require vocational rehabilitation. Vocational rehabilitation covers support in the work place, negotiating/adapting working conditions, access to benefits, further training and much more. This service will not require any additional funding, as the service is paid for by the Department of Work and Pensions. A cardiac rehab nurse will simply discuss issues in the work place following a cardiac event, confirm eligibility criteria to assessing the service, and send a referral to a charity organization to continue the vocation support. Cardiac patients entering into this referral system will continue to complete their NHS based rehab. If you are currently working and feel you have problems or may lose your job as a result of your cardiac event, or if you are not employed but wish to start full time work, this referral service may provide benefits. Examples of the initial support that can be assessed are: work station assessment supplying ergonomic aids negotiating a phased hour return or start to work further training or re-training in other disciplines mentoring support confidence/self esteem building CV writing/job searches/interview experience. Individuals often don t realise that tackling concerns head on in the work place leads to a faster recovery. Meetings can be set up with employers to discuss possible changes to the job, to make it suitable to a cardiac patient. Overall the project aims to: provide a vocational rehabilitation pathway as an additional resource within a cardiac rehabilitation menu allow patients to receive specialist information and guidance on vocational rehabilitation increase the number of patients within a working age (if eligible for the service) returning to employment having received specialist support based on their post cardiac event needs support those patients who were previously not employed (if eligible for the service) to seek methods for coming off state benefits and attaining full time employment based on their post cardiac event needs increase the vocational rehabilitation knowledge of the healthcare professionals involved in the pilot increase the number of resources available within the remit of cardiac rehabilitation allow patients to receive more continuity of care. Jason Antrobus, jason.antrobus@nhs.net North West London Cardiac and Stroke Network 6 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

7 Cardiac Rehab UK National Priorities project in Dorset In July 2008, Dorset Cardiac Network submitted an application to the NHS Improvement Programme to become a demonstration site for the Cardiac Rehabilitation National Priorities Project. This application was accepted and includes the three main Dorset hospitals; Poole, Bournemouth and Dorchester. The project is to run over the next three years. The aims of the project are: to improve equity of provision, uptake and access to cardiac rehabilitation across Dorset to meet the minimum British Association for Cardiac Rehabilitation (BACR) Standards and Core Components (2007) to provide a menu driven service to suit the individual needs of patients to agree a Dorset wide service specification which would form a basis by which all future services will be commissioned to keep patient and public involvement central to the project. In September 2008, the project team was established and included support from a lead board level director, consultant cardiologist and a clinical and management lead from each hospital. A Dorset wide cardiac rehab sub group of the Cardiac Network Board was developed to meet regularly to plan and evaluate progress. Baseline assessments of each hospital s current cardiac rehab service were completed and collated. Overall, the three hospitals were relatively similar, with gaps in the standards tending to be generic across all three sites. For example, no psychology service, no home based cardiac rehab programme and shortfalls in staffing compared to levels recommended by the BACR. An action plan was drawn up at the last cardiac rehab sub group meeting in May 2009 to address these needs. The pan-dorset Cardiac Rehabilitation sub group Geographically the areas served by each hospital are quite different; Poole and Dorchester are very rural, whereas Bournemouth is densely populated. Therefore, the second part of the project is to measure uptake and access of Phase III of cardiac rehab across the whole of Dorset. Between January and March 2009 each centre audited patients referred to them, and will follow them up six months later, to measure how many complete the programme. The audit includes GEO mapping to assess which areas have a better uptake of rehab. It has been important to involve local patients / service users to ensure involvement in line with the Patient and Public Involvement (PPI) strategy. Patient representatives have attended the sub group and national meetings. Discovery interviews with patients have led to process mapping of patient information and literature to improve the patients experience and pathway of care. The project continues and already there have been many benefits including raising the profile of cardiac rehabilitation locally and nationally, the opportunity to network and share best practice with other centres and improving the patients experience. In the long term, the project will help to develop a Dorset wide specification to ensure equity of provision of cardiac rehabilitation for patients across the whole county. Linda Everett, Cardiac Rehab Lead, Poole Hospital Linda.everett@poole.nhs.uk The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 7

8 Cardiac Rehab UK September 2009 BHF Publications UPDATE News News News Children with congenital heart disease DVD A DVD for parents whose children have recently been diagnosed with congenital heart disease, and for health professionals who work with families. In this DVD you will meet three families who share their experiences from diagnosis to treatment. Through conversations with staff at the Evelina Children s Hospital, the DVD addresses the most common questions, concerns and emotions that parents have, and provides practical support and guidance. This DVD replaces our videos 'Children and heart disease', 'Children and catheterisation' and 'Children in surgery and intensive care'. Stock code DVD24 Live with a healthy heart A combined DVD and booklet produced for people with learning disabilities to help them understand the risk factors associated with coronary heart disease. The introductory chapter uses animation to describe how coronary heart disease and its risk factors affect the heart. The following 5 chapters are case studies presented by people with learning disabilities about themselves and how they changed their lifestyles to reduce their risk of heart disease. The booklet reinforces the messages portrayed in the DVD and signposts individuals to other sources of information to support their lifestyle changes. Stock code G minutes a day poster Promoting 60 minutes of physical activity a day to children and young people in schools is the key message communicated by new BHF posters, one for primary schools and a set of two for secondary schools. There is a different version of each poster for each of the four UK countries, which have also been branded by the leading health agency for each country. When ordering, these please indicate which UK country they are for. Stock code G433 (A2 primary school poster) How to order Call the order line on , orderline@bhf.org.uk or visit bhf.org.uk/publications where you can order or download the publications. G432A and G432B (A1 secondary school posters which must be ordered together) Update on the Cardiac Rehab UK evaluation I would like to take this opportunity to thank everyone who took the time to complete the questionnaire. We received a good response and your feedback is invaluable to the future of the newsletter. Congratulations to Julia Wright, who wins a place at the 2009 BACR Conference. The findings Overall, we had very positive feedback about the newsletter. It is a valued resource and, other than the BACR website, the only mentioned source of information on cardiac rehabilitation. A high percentage of readers said they would be interested in reading about other cardiac conditions, and all your comments and suggestions have been taken on board. We are aware that the newsletter is not reaching enough sub groups, and we are looking at ways of increasing the scope of distribution. The newsletter is a free resource and is available to anyone. The future We will continue to produce three issues per year in the current 12 page format. In addition to providing it in hard copy and as a PDF via , we are also setting up a dedicated page on the main BHF website. This will enable readers to download all back issues of the newsletter from one location. We are looking at widening the remit of the newsletter to include articles about innovative practices within other cardiac conditions, and will keep you updated via the newsletters. If you know anyone who would be interested in submitting an article, or receiving this resource, please ask them to contact me on the below. With thanks again for your continued support Anu Mukherjee, Editor, on behalf of the Cardiac Rehab UK editorial team 8 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

9 Cardiac Rehab UK News News News News News News News News News Make this cookbook your cardiac companion Sometimes great ideas are inspired by a simple request for more information. The Cardiac Cooking Companion is a freely available electronic internet cookbook aimed at cardiac patients and their families. Y Cyfaill Coginio Cardiaidd Cardiac Cooking Companion It came about through collaboration between cardiac rehabilitation dieticians and local cardiac support groups in Wrexham, North Wales. When asked to suggest ways of providing additional dietary support, the overwhelming response from patients was a request for heart healthy recipes from a trusted source. The concept of an environmentally friendly, cost effective and comprehensive cookbook was formed. With over 80 easy to follow recipes, the cookbook also includes healthy cooking and shopping tips, information on understanding food labels and plenty of ideas on how to add flavour to foods without resorting to the salt cellar. It also outlines the principles of the cardioprotective diet, and thus can be a very useful introduction to healthy eating for individuals unable to travel to education sessions. Many of the recipes were provided by local cardiac rehab users and the project is actively seeking contributions to future editions. Feedback from users has been excellent, and since launching it has been downloaded more than 5,000 times. While everyone does not have internet access, family members and friends are usually willing to help and many find it a practical way to assist in the recovery of their loved ones. We are particularly proud of the fact that one in every three downloads has been of the Welsh version (Y Cyfaill Coginio Cardiaidd). Furthermore, the project won the Food Standards Agency Award for Food Action Locally, and is widely used in community cook and eat sessions run by voluntary organisations. If you would like to obtain a copy and find out how your patients can access the cookbook please paul.greene@wales.nhs.uk Cardiac rehabilitation tariff and JBS3 The British Cardiovascular Society (BCS) is leading on the new Joint British Societies Guidelines (JBS3) and the BACR and NHS Improvement are represented in the working group. The first meeting took place on 13 July 2009 where an 18 month target was agreed, and a series of meetings will take place over the next 12 months to review the evidence in each of the areas. The BACR and NHS Improvement will be working on a parallel work stream on the CR tariff which will consider phases I to III. The rehabilitation tariff will be developed by a joint approach between an expert reference group and the information centre. CR will form a significant part of the tariff and Prof. Doherty will represent NHS Improvement and the BACR. The first meeting took place in July 2009 and a series of communications and further meetings will take place over the next two years. We will look to use NHS Improvement national priority CR projects to inform the process. Professor Patrick Doherty bacr@bcs.com National Clinical Lead, NHS Improvement Heart President BACR C R NACR update National Audit Well done to all Approximately 74% of cardiac rehabilitation programmes in the UK have now registered with CCAD to use the data base. The use of NACR and the cardiac rehabilitation campaign are now having the desired effect of raising the profile in Parliament, with more than 100 questions asked in parliament compared to the 10 in the previous 10 years. Changes The full potential of the NACR will only be achieved through close collaboration with clinical teams. Changes to the database took place on 1 April following feedback from clinicians, and others will appear in due course. Some areas e.g. Wales have established small groups to collectively support the development of NACR and work closely with the team in York. Web changes Work in this area continues, the web version currently does not do all that can be done on Lotus and therefore you are advised to try the web version first to decide if it meets your needs. Reports If you require help with reports please contact Veronica at York, vm9@york.ac.uk or Training Training is free of charge and takes place at the University of York. For further information please contact Nerina, neo500@york.ac.uk or Dates planned 8 September, 5 October, November TBC, 8 December. The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 9

10 Training opportunities BACR Phase IV Exercise Instructor Training (20 REPS CPD points) Level 4 Qualification recognised by SkillsActive and the Register of Exercise Professionals Specialist training for exercise professionals who want to prescribe and deliver exercise programmes as part of the overall long-term management of individuals with heart disease.this is an assessed course and therefore has a strict qualification and experience entry criteria - For REPS level 3 exercise instructors Venues across UK including Exeter, Belfast, Manchester, Gloucester, Solihull, Glasgow, Newcastle, Leeds, Alton, Amersham, Derbyshire, Loughborough, Central London see for up to date list. Cost: 595 (includes course fee, course material and assessment) Duration: 5 days Knowledge and Skills update study day (4 REPS CPD points) Open to BACR exercise instructors only This study day is run by BACR Phase IV course directors and aims to update and consolidate on areas which are relevant to everyday practice for BACR Phase IV instructors. 30 October 2009, Glasgow 28 November 2009, Leeds 29 January 2010, Central London Vivienne Stockley Tel: vivienne@bacrphaseiv.co.uk Cost 90 ( 85 to BACR members) A Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease (PART I) Open to exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients in primary/secondary health care setting This two day course aims to explore the principles of exercise and physical activity in cardiovascular disease prevention and rehabilitation and apply these principles to design and delivery, using an evidence-based approach. It aims to assist health professionals with useful tips and suggestions regarding physical activity and exercise advice, exercise prescription, planning and delivery that can be implemented in future service developments. 20/21 November 2009, Chester University, Cheshire Vivienne Stockley Tel: vivienne@bacrphaseiv.co.uk 26/27 November 2009, London, University College Hospital Vivienne Stockley Tel: vivienne@bacrphaseiv.co.uk 19/20 February 2010, Cramlington, Nr Newcastle upon Tyne Coral Hanson Tel: coral.hanson@northumberland.gov.uk 5/6 March 2010, Alton, Hampshire Dr Julia Evans Tel: julia@cardiac-rehab.co.uk 16/17 September 2010, Imperial College London (Charing Cross Hospital) Vivienne Stockley Tel: vivienne@bacrphaseiv.co.uk Cost 280 ( 250 to BACR members) Duration 2 days Advanced Application to Physical Activity and Exercise in the Management of Cardiovascular Disease (PART II) Provides an excellent follow on from the A Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease course and is open to all BACR exercise instructors This course aims to encourage all professionals delivering the exercise component of cardiac rehabilitation to explore current practice and guidelines. Clinical reasoning skills will be encouraged through facilitated workshops to enable practitioners to interpret and adapt evidence in order to manage patients whose status falls outside the recommended guidelines. 25/26 September 2009, Alton, Hampshire Dr Julia Evans Tel: julia@cardiac-rehab.co.uk 29/30 October 2009 Kegworth, Derbyshire Sara Bambrough Tel: Sara.bambrough@nhs.net 19/20 March 2010, Alton, Hampshire Dr Julia Evans Tel: julia@cardiac-rehab.co.uk Cost 280 ( 250 to BACR/ACPICR members) Duration 2 days One day courses on specific elements relating to Physical Activity and Exercise Assessment, Prescription and Delivery of Physical Activity and Exercise in Heart Failure Open to BACR Exercise Instructors and exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients in primary/secondary health care setting. This course focuses on heart failure pathology and relates exercise physiology, medications and devices to the principles of exercise training in this population group. 4 September London, University College Hospital Vivienne Stockley vivienne@bacrphaseiv.co.uk November 2009 West Suffolk Hospital, Bury St Edmunds, IP33 2QZ Sarah Hinchliffe/Mel Amps Sarah.Hinchliffe@wsh.nhs.uk or melanie.amps@wsh.nhs.uk Cost 145 ( 130 to BACR/ACPICR members) A Practical Course in Assessing Functional Capacity in Clinical Populations Open to BACR Exercise Instructors and exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients in primary/secondary health care setting. 10 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

11 This one day practical study day aims to increase the knowledge and skills in implementing a number of functional capacity tests used in population groups such as cardiac and respiratory patients (e.g. Incremental Shuttle Walk Test, 6-Minute Walk Test, Chester Step Test, Cycle Ergometry) as well as practically apply the results to exercise prescription. 9 September 2009, Mater Hospital, Belfast Bernie Downey bernie.downey@belfasttrust.hscni.net 14 November 2009, Cramlington, nr Newcastle Coral Hanson Tel: coral.hanson@northumberland.gov.uk 17 April 2010, The Octagon, Hull Nicky Gilchrist Tel nicola.gilchrist@hey.nhs.net Cost 145 ( 130 to BACR/ACPICR members) Practical Skills in Delivering Effective Group Exercise in Cardiac Rehabilitation Open to BACR Exercise Instructors and exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients in primary/secondary health care setting. This one day practical study day aims to develop practical exercise delivery skills and competences for delivery of group based cardiac rehabilitation. 11 December 2009 Central London Vivienne Stockley vivienne@bacrphaseiv.co.uk Cost 145 ( 130 to BACR/ACPICR members) Rating of Perceived Exertion Study day Open to BACR Exercise Instructors and exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients in primary/secondary health care setting. This one day course is aimed at all health and exercise professionals working in cardiac rehabilitation to ensure the appropriate, consistent and valid use of Borg's RPE scales. 17 October 2009 University of Chester, Chester Vivienne Stockley vivienne@bacrphaseiv.co.uk November 2009, Cramlington, nr Newcastle Coral Hanson Tel: coral.hanson@northumberland.gov.uk 16 April 2010, The Octagon, Hull Nicky Gilchrist Tel nicola.gilchrist@hey.nhs.net Cost 145 ( 130 to BACR/ACPICR members) Physical Activity and Exercise Advice in Heart Failure Open to heart failure and cardiology nurses who wish to develop their knowledge of physical activity and exercise advice in heart failure This course will relate exercise physiology to the principles of exercise training in this population group. Applicants should have prior knowledge of heart failure pathology. This course is not aimed at professionals who have the relevant qualifications to prescribe exercise to the cardiac population. Cost 145 ( 130 to BACR/ACPICR members) Psychological Issues for Health Professionals working in Cardiac Rehabilitation Open to health professionals working with cardiac patients in primary/secondary health care setting and BACR exercise instructors who are working within a phase III cardiac rehabilitation team An evidence and practice-based course designed to help multidisciplinary team members increase their confidence in identifying psychological issues, and to explore ways of incorporating psychological principles within cardiac rehabilitation programmes.this course is designed for cardiac rehabilitation professionals who already have experience of working in cardiac rehabilitation settings. 12/13 March 2010 Bridgend Linda Speck linda.speck@bromortr.wales.nhs.uk Cost 280 ( 250 to BACR members) Duration 2 days Reducing the Risk of Cardiovascular Disease and Managing Weight: A Dietary and Behavioural Approach 20 November 2009 Central London Vivienne Stockley Vivienne@bacrphaseiv.co.uk Cost 145 ( 130 to BACR members) How to Ensure Your Cardiac Rehabilitation Programme Meets BACR Standards Open to all health professionals who are interested in the service delivery of all components of cardiac rehabilitation The aim of this one day is to explore the latest trends for all components of cardiac rehabilitation including service delivery. Reflection on practise will be encouraged allowing practitioners to assess how their service maps to current national guidelines including BACR Standards. January 2010 Cost 145 ( 130 to BACR members) All the above courses will fulfil compulsory CPD requirements and a certificate of attendance will be issued. Please contact the BACR Education Office for application forms or details on hosting any of the above courses; enquiries@bacrphaseiv.co.uk , The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 11

12 Cardiac Rehab UK September 2009 Courses and conferences BACR Annual Conference October 2009, Jury s Inn, Birmingham Open to all professionals working in cardiac rehabilitation, this two day conference will include talks on building business cases, educating patients, working with the elderly, psychobiology of exercise, examples of innovative practice and selected abstract presentations. It is possible to attend only one of the days, if preferred, and there is an optional dinner followed by DJ on the Thursday night. Fee for full attendance: Members 150, Non-Members 190 Tel: bacr@bcs.com BHFNC 9th Annual Conference National policy to local practice: Working together to deliver physical activity programmes 18 November 2009, East Midlands Conference Centre This year s annual conference aims to provide evidence and practical guidance on how to deliver effective, coherent and co-ordinated physical activity programmes. It will also provide an excellent opportunity for delegates to discuss and debate how different sectors and organisations can work together to achieve this. Each of the conference workshops will offer a valuable insight into the importance of working in partnership to deliver physical activity. As a response to delegate feedback, we are offering workshop sessions which allow greater opportunities to share experiences and network with other professionals. Cost: VAT For further information on workshops, keynote sessions and how to book your place go to bhfactive.org.uk/downloads/final_flyer.pdf CHD Prevention Online This is a degree level, fully online module for practice nurses, community nurses and all those working in cardiac rehabilitation. Using CHD Prevention Online you can develop core skills for clinical practice in coronary heart disease prevention. The course content is linked directly with patient cases and covers primary and secondary prevention. Study wherever you have internet access. You can also share ideas with colleagues from around the country. We bring all the latest research to within a click of your desktop. This module offers you the opportunity to practise in a safe environment using simulated patients. You will be building up evidence of your learning online as you go, and we will assess this by portfolio. Each week you ll be working with a simulated patient online. With each patient you ll undertake a range of activities, all designed to develop your assessment and management of CHD. At the same time our expert tutors will help you access the latest research and evidence base. They will also provide support for your learning. CHD Prevention Online can be used to contribute to a degree if you wish, as it will give you 20 credits at Level 6. No previous experience of study at this level is required. The course is taught online, with no attendance at study days. Access to all the evidence and clinical guidelines is provided by the course on the internet. Cost: 550 per student For details contact Ros Brownlow on or rm26@york.ac.uk The Cardiac Rehab UK Editorial Team Content Managers: Linda Binder, National Improvement Lead - Heart (NHS Heart Improvement Programme) Diane Card, Community Development Manager (British Heart Foundation) Linda Edmunds, Council Member (British Association for Cardiac Rehabilitation) Editor: Anu Mukherjee, Project Officer, British Heart Foundation Cardiac Rehab UK is a free newsletter aimed at health professionals either working in or with an interest in cardiac rehabilitation. To subscribe, submit an article or contact the editorial team, cardiacrehabuk@bhf.org.uk Deadlines for submissions Issue 16, January 2010 Friday 30 October 2009 Access the Newsletter online The current issue and back copies are available to download from The current issue is also available via the BACR website This is the official newsletter of the British Heart Foundation (BHF) and the British Association for Cardiac Rehabilitation (BACR). Views or opinions that appear or are expressed in articles and letters by an individual do not necessarily represent those of the BHF or the BACR and neither do the organisations endorse any products or services advertised. BHF and BACR do not accept liability for its contents or for consequences which may result from the use of information or advice given. M The British Heart Foundation is a registered charity in England and Wales (225971) and in Scotland (SCO39426).