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• Lecture captures

• Knowledge checks

• Interactive learning tasks

• Signposting to key

guidelines

• Learning resources

• Self-assessment

• Lecture captures

• Knowledge checks

• Interactive learning tasks

• Signposting to key

guidelines

• Learning resources

• Self-assessment

In this Issue

BACPR National Accreditation Scheme

BACPR Annual Conference 2013

CRIGS Feature

The Magazine from the British Association for Cardiovascular Prevention and RehabilitationJULY 2013

BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION AND REHABILITATION

BACPR Connect

“Promoting excellence in cardiovascular disease prevention and rehabilitation”

BACPR Exercise Instructor revalidation now online. Winter 2013/2014 will see the launch of the BACPR Standards and Core Components as an online course

Follow us on Twitter

@bacpr

BACPR ANNUAL CONFERENCE 2013Celebrating the 20th anniversary of BACPR

Join the celebrations in Solihull 3rd and 4th October 2013

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Message from the Editor Katherine Paterson, Editor

Welcome to this issue of BACPR CONNECT. Everyone has been working extremely hard and that includes BACPR members who have proposed a joint statement with the Resuscitation Council (UK) updating the guidelines on the requirements for resuscitation training and facilities for cardiac rehabilitation programmes. I am glad to say that we have managed to capture in the nick of time the highlights of our recent Exercise Professional’s Group (EPG) spring conference on Heart Failure and exercise. Reading through the summaries, for example on the HF (Heart Failure) Action trial, has left me in suspense and eager to log onto our members only site to see the slides for more. Our Exercise Instructors’ Network (EIN) has been busy voting for their newly elected committee at their Annual General Meeting held at the EPG conference. They have been running courses on obesity, and share some comments from attendees in their update. In fact EIN Communications link, Marie Toms also shares with us her experience in the Bahamas where she trained as a Cardiac Yoga teacher having won the BACPR travel award last year!

Please enjoy the read and all the updates kindly provided by our partners, Council members and affiliates.

Message from the President Jenni Jones, President

As we welcome the summer and hopefully some sunshine with it, on behalf of the BACPR thank you for joining us in this new membership year. Given the challenging financial times your continued support in joining our collective voice to provide high quality care to people affected by, or at high risk of developing, cardiovascular disease is particularly appreciated.

This edition of BACPR CONNECT will be the last during my Presidency and I’d like to therefore take this opportunity to offer my sincerest of thanks to the truly great people that are involved in your Council. They work SO hard and in the most part comprise of volunteers juggling the day job, family and work; everyone so passionate and putting in significant time, effort and dedication for our shared ambition to provide our members with support, a valuable membership experience and promote excellence in cardiovascular disease prevention and rehabilitation care at a national level. Professor Gill Furze takes over this October and has been a fantastic support throughout her 2-year President-Elect term Our association is very fortunate to welcome her as our President in the near future.

This year’s annual conference is just around the corner and importantly marks our Association’s 20th anniversary. Thank you to all the conference organising committee for putting together what looks like a truly fantastic event! There is much to celebrate: membership to BACPR is growing; our education team continue to develop and deliver nationally reputed high quality programmes and training; we are leading an international council on cardiovascular prevention and rehabilitation comprising 13 organisations worldwide; and our new standards and core components are reaching further through publication in a high impact journal… to name but a few. Consequently, Solihull provides an opportunity to celebrate the many considerable achievements made and acknowledge the BACR’s foundation by Dr Hugh Bethell in 1993.

On behalf of the BACPR, I’d also like to thank Samantha Breen as she steps down as Chair of the EPG following 2 years of capably leading and developing this subgroup of BACPR. Welcome to Gordon McGregor as he now officially takes the reins. A special thank you to Dr John Buckley and Dr Linda Speck, who both step down from Council as Elected Officers this October, for their enormous contributions, commitment and support over the past 6 years.

We are really pleased to officially welcome the BACPR-Exercise Instructor Network as a BACPR sub-group and look forward to working with Susan Whyte as Chair in engaging the large body of over 2,000 instructors to be part of their awarding association and ensuring our qualified instructors’ needs are also met. We also launch our new ‘Nurses Forum’ under the leadership of Alana Laverty and look forward to better supporting our nurse membership.

In closing, a special thank you and congratulations to the many individuals who have contributed to yet another impressive BACPR CONNECT communication, together with Kath Paterson for her editorial mastery. We hope you all enjoy this amalgamation of their significant efforts, dedication and time.

On behalf of all the Council, our greetings and thanks to you as our members and hope to see you in Solihull in October!

Message from the Editor and President 2

Latest News 3

Membership Update 4

BACPR Annual Conference 2013 5

News from the British Heart Foundation 6

NHS Improving Quality 8

Department of Health News 8

National Audit of Cardiac Rehabilitation 8

News from our Key Affiliates 9

National Accreditation Scheme 10

ICCPR News 11

New Scientific Publications to inform your Practice 12

Omega-3-acid ethyl esters feature by Abbott 13

BACPR-Exercise Professionals Group Report 14

BACPR Exercise Instructor Network Update 14

News from CRIGS 15

News from the Regions 16

BACPR Travel Award 2012 Report 17

BACPR Education and Training 18

Forthcoming BACPR Courses 19

Diary Dates 20

Contents

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Cardiac Rehabilitation and Prevention The Current Issues in Cardiac Rehabilitation and Prevention (CICRP) newsletter was published in May 2013 – the joint publication with the Canadian Association for Cardiac Rehabilitation (CACR) helping you to transform the latest evidence into front-line practice. The theme for this latest edition is women and heart disease and there are some GREAT articles. Visit the ‘other resources’ section of the members only area to access this latest journal.

Latest news

BACPR Competences Frameworks UpdateHaving completed the competences required for staff leading the physical activity and exercise component of cardiac

prevention and rehabilitation services, BACPR is currently developing a competency

document to support the delivery of ‘Health Behaviour Change and Education’ – integral elements to all other components of cardiovascular disease prevention and rehabilitation. This is well underway and expected to be piloted during the autumn and published by the end of the year.

CALLING ALL MEMBERS: Interested in joining the

working groups to develop the BACPR competences frameworks for smoking cessation and diet???

We need your help!

For further information: Annie Holden, Lead for BACPR Competences Project, annie.holden@mytimehealth.co.uk

The International Charter on Cardiovascular Prevention and RehabilitationA call for action was published in March this year.

Globally systematic access to cardiac rehabilitation is lacking. This is despite the increase in cardiovascular disease in low to middle income studies coupled with the fact that CVD is the main cause of death worldwide. The paucity of access means that people with CVD may suffer from further acute care events and die prematurely.

The 2 aims of the charter are:

“1. to bring together national associations from around the world to harmonize efforts in promoting cardiovascular prevention and rehabilitation;

2. to document consensus among national associations globally, regarding the internationally common core elements and benefi ts of cardiovascular disease prevention and rehabilitation.”

As well as citing the strong evidence base for the benefi ts of cardiac rehabilitation, the 9 international authors, including Jenni Jones, President of BACPR and John Buckley, former president, call for healthcare providers “to no longer deny patients with CVD access to cardiovascular prevention and rehabilitation”.

Download this article in the members only area: Grace et al. (2013). Journal of Cardiopulmonary Rehabilitation & Prevention Volume 33 p 128-131: International Charter on Cardiovascular Prevention and Rehabilitation.

Visit the ICCPR website too and see what’s happening in cardiovascular prevention and rehabilitation Worldwide! www.globalcardiacrehab.com

BACPR Publishes Scientifi c Statement in Heart In February this year our submission to HEART was accepted for publication and can be found in the Heart Online First for 12 Feb 2013 and has just been published in the July edition (Heart, 99 (15): 1069-1071). Those of you who are BACPR-BCS members will be able to login to your members’ only area of the BCS website and access the article. Those of you who have access to Heart through your institutions will be able to use the links provided within the Heart website. This publication is an abridged version of the BACPR Standards and Core Components in Cardiovascular Disease

Prevention and Rehabilitation (2nd Edition) and takes the form of an editorial communicating the need to invest in evidence-based cardiac rehabilitation. This is a real landmark for BACPR and puts our standards and core components to wide readership and potential citations.

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BACPR led a successful second affiliate day programme at BCS Annual Conference 2013 in June, in collaboration with BANCC and BSH.

See the presentations in the members only area under conference presentations

The day covered the breadth of the subject area from prevention, beginning in utero, through early manifestation of disease through

linked data bases, to overt severe and acute cardiovascular disease exemplified by heart failure.

Professor Lucilla Poston gave a fascinating presentation on the earliest influences on the foetus and maternal health in the development of cardiovascular disease.

Dr Clare Hawley presented a thought provoking session on the impact of alcohol on the heart. Professor Roger Boyle, the Heart Tsar whose contribution to

reducing the burden of cardiovascular disease in the NHS has been formidable, gave a highly convincing presentation on why the NHS needs to make prevention more of a priority. The final session included Dr Gavin Sandercock presenting the latest evidence in cardiac rehabilitation. This session is particularly relevant to BACPR members and calls for us all to objectively measure what we achieve in terms of gains in physical fitness.

Do you achieve at least a 1.5 MET gain in fitness in your programme???

Membership UpdateWe hope that the resources BACPR have provided and will continue to develop are valuable and continue to offer you support with many of the challenges being faced by those working in cardiac rehabilitation in this current climate.

We’re delighted that 2012-2013 welcomed more BACPR members. Year on year we are growing with our membership numbers peaking at 940 at the end of the last financial year.

Membership Numbers 2012-2013

PROFESSION Apr 2012- Mar 2013

Nurse 377

BACPR Exercise Instructor 239

Physiotherapist 131

Other Exercise professional 38

Exercise Physiologist 37

Occupational Therapist 11

Doctor 24

Dietitian 10

Research Fellow Academic 9

Psychologist 11

Other 42

Not specified 11

TOTAL MEMBERSHIP 940

We strive now for your continued support as well as reaching out to your colleagues for growing representation across all (but particularly those under-represented) professional backgrounds.

I would like to personally thank everyone for renewing their membership recently. We do appreciate these are challenging times for us all but we truly believe that together we are stronger and that this will help us achieve our goal of promoting excellence in cardiovascular disease prevention and rehabilitation.

Mima Traill (Honorary Secretary and Chair of Membership and Communications)

As BACPR members you can access our support service. We strive to answer your queries within 10 working days.

CLOSING DATE APPROACHING FOR THE 2013 TRAVEL AWARD

In this edition you can read about our last year’s winner of the travel award and her very successful trip to Nassau to explore the use of yoga in cardiac rehab. As BACPR members you too can apply for this award. The criteria are:

• You need to have been a BACPR member for two continuous years.

• The maximum amount that can be awarded is £2,000 so any additional costs would need to be picked up by you.

• BACPR courses and conferences are not eligible for this award. • Once the award has been granted, the amount cannot be

changed under any circumstances.• Payment will be made on the production of receipts after the

event has taken place. • You will be required to write a report for the BACPR special

edition newsletter and website • You may be required to give a presentation on the outcomes/

benefits of the visit at a BACPR event.

The closing date for applications is the 31st August 2013 and full details can be found on our website.

?

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The St Johns Hotel, Solihull is the venue for this special occasion. St Johns is a modern and spacious conference venue and hotel and provides an ideal location on which to hold our annual conference. Registration is now open and we recommend that delegates book early to avoid disappointment – as we had to close registration last year due to maximum numbers being reached.

Your 2013 conference sessions include:

• The NEW Cardiovascular Disease Outcomes Strategy by Professor Huon Gray, National Clinical Director for Heart Disease

• ‘Mars and Venus in the waiting room: Gender bias in clinician communication’ by Damian Edwards, Director of Behavioural Interventions, National Obesity Forum

• ‘Moving with the evidence – advancing practice through the latest clinical guidelines’ by Professor Joep Perk, Chair, Joint European Societies

Taskforce Chair• ‘Celebrating the 20th anniversary of

BACR and BACPR’ by Dr Hugh Bethell, Founding President of BACR

• Exercise Professionals Group (EPG) session ‘Cardiac Rehabilitation and the Exercise Component – Advances of the Past 20 Years’

• Guidelines for CRT and ICDs and the role of cardiac rehabilitation post CRT by Dr Chris Pepper, Yorkshire Heart Centre

• ‘Managing stable angina’ by Dr Mike Fisher

• Technology Highlight Session: Integrated Solution for Cardiac Rehabilitation, sponsored by Janssen Healthcare Innovation

• Special CRIGS session ‘Developments in cardiac rehabilitation for heart failure

• National Updates from Wales, Scotland, Northern Ireland and England

• BHF and NACR Updates• NEW NICE Update on MI Secondary

Prevention by Dr Phil Adams (Guideline Development Group Chair)

And also:• Thursday evening 20 year celebratory

gala dinner with an after dinner speech by Damian Edwards followed by disco

• Parallel sessions to include the BACPR Nurses Forum, Psychology and dietetic options

• Lunchtime symposia session ‘Setting the PACE: Reducing mortality in Post-MI’ sponsored by Abbott and delivered by Bernie Downey

• Further lunchtime symposia by Menarini and Unilver

• Moderated Poster Presentation session • Oral abstract presentations

A CONFERENCE NOT TO BE MISSED!

To fi nd out more about registration and how to book accommodation for the conference, visit www.bacpr.com. We look forward to seeing you in Solihull.

Gail SheppardScientifi c Offi cer

BACPR CONFERENCE 2013 is almost here! Join us to celebrate 20 years. Preparations for the BACPR’s 20th Anniversary are well underway as we aim to bring you, the members, a programme full of innovative, interesting, stimulating and inspirational sessions under our theme this year; ‘Back to the Future – Advances in Cardiovascular Prevention and Rehabilitation’.

BACPR ANNUAL CONFERENCE 2013Celebrating the 20th Anniversary of BACPR

nurses ForuM

We’re delighted that Alana Laverty (Ordinary Council Member) will be leading this activity in conjunction with members who have expressed interest in getting involved. The next CONNECT will feature their activities in meeting the needs of our nursing membership specifi cally.

”“

HOT TOPICS IN THE DISCUSSION FORUM ON THE WEBSITE

HOT TOPICS IN THE DISCUSSION FORUM ON THE WEBSITE

Timescales for recovery guidelines post MI/PCI

Fasting Diet

Sauna & Steam Room Guidance for Post CABG

Pre stretches in rehab class

Consultant Champion for Cardiac Rehabilitation

Dietary audit tools

Abdominal Aortic Aneurysm exercise guidelines

Community emergency resuscitation equipment

……and more!

6

News from the British Heart Foundation Compiled by Diane Card supported by several colleagues within the BHF

‘Supporting Healthcare Practitioners’

Funding for heart health professional developmentDo you spend a significant amount of time working with cardiac patients? The BHF offer funding to healthcare practitioners and those involved in educating people affected by heart disease.

We provide:

• Financialassistanceforeducationopportunities

• Accesstoconferencesandevents

• AccesstoBHFcourses

• Membersonlywebsiteandresources

• FreemembershiptoourHeartMattersprogramme

• Networkingopportunities

Get in touch if you want to find out more, contact us at bhfhi@bhf.org.uk

Cardiac rehabilitation updateWales

In Wales BHF are no longer actively lobbying AMs about Cardiac rehabilitation; however BHF work closely with the All Wales Cardiac Rehabilitation working group and are keeping a watchful eye on development. We are also closely monitoring the development of the new Heart Disease Service Delivery Plan, which has recently been out for consultation, to ensure Cardiac rehabilitation is recognised and included with commitment from Welsh Government and Local Health Boards to ensure evidence based CR is delivered to patients across Wales.

Scottish Parliament, Debating Chamber– 24th January 2013Members’ Debate on Cardiac Rehabilitation

The debate was led by Helen Eadie MSP (Convenor of the Cross Party Group on Heart Disease & Stroke), secured following her Parliamentary Motion (October 2012), in support of BACPR Standards & Core Competencies 2012.

Helen congratulated BACPR on the publication of the standards and the ‘compelling case’ presented to extend cardiac rehabilitation provision to all heart patients. Helen also took the opportunity to present evidence on the cost-effectiveness of CR, highlight the very low rates of CR for those with heart failure and angina and repeat her call for ‘every heart patient to be referred to CR as matter of course.’

Helen was followed by 4 MSP colleagues, representing all of the key parties within the Scottish Parliament. Quite a feat and only topped by all participants agreeing, in full and regardless of political boundaries– a rare occurrence! The debate was very good humoured with each MSP emphasising the evidence; published, anecdotal from constituents and in one case, personal experience. They all agreed that CR should be available to every heart patient and they each called on the Scottish Government to take urgent action.

‘Referral to CR should be mandatory for all heart patients, as with the prescription of cardiac medicines’ [Dave

Thompson MSP – Scottish National Party]

‘Cardiac Rehabilitation saves and transforms lives’

[Jackie Baillie MSP – Scottish Labour Party]

‘It’s about saving lives, its about enhancing life, about returning to ‘normal’ life’

The Scottish Campaign for Cardiac Rehabilitation were delighted to hear all of the MSPs declare their support for the introduction of a HEAT Performance Target to NHS Scotland; making referrals to CR mandatory. We were even more delighted when Michael Matheson MSP, Minister for Public Health (providing the govmt response) declared: ‘put simply, CR is an inexpensive treatment, which saves lives’; he confirmed that the introduction of a HEAT Target is one of the options he has asked the National Advisory Committee for Heart Disease to consider at their meeting next month.

A hugely encouraging debate, which demonstrated the breadth and strength of support, across all political parties and a massive step forward on campaign calls for the introduction of mandatory provision of CR in Scotland.....watch this space!

England

BHF has taken the decision not to take an active role in driving the profile of cardiac rehabilitation forward but will be working closely on cardiovascular disease outcomes strategy to ensure that it remains on the political agenda as part of this strategy.

Heartwatch

An important development in our campaign around cardiac rehabilitation services will soon be available is the results of our Heartwatch survey. The British Heart Foundation surveyed heart patients in 2012 to ascertain if they were offered rehabilitation services, if they attended the services offered, and any reasons for nonattendance. The results of this survey will be published in Summer 2013 and will be used to look at what more local commissioning groups can do to improve the services offered to patients.

Update on British Heart Foundation CampaignsEvery Child a Life Saver

The British Heart Foundation is campaigning with the Resuscitation Council UK to see emergency life saving skills (ELS) taught as part of the national curriculum in England. We have been mobilising the public, BHF campaigners and working with politicians at Westminster to encourage the Government to make ELS a mandatory activity in the school year. Over 100,000 people signed petition, which was handed in to number 10 Downing Street by MPs from all of the major political parties alongside Fabrice Muamba, the Bolton footballer whose life was saved when he suffered a cardiac arrest while playing football in 2012. The BHF estimates that around 1 in 7 children in secondary education in England receive training that could help them potentially save a life. This campaign is part of our on-going work to improve the survival rates from out of hospital cardiac arrests and increase the likelihood of bystander interventions.

7

Westminster Government announces new Cardiovascular Strategy for England

In March 2013 the Westminster Government launched the new Cardiovascular Disease Outcomes Strategy in early March.

The Outcomes Strategy sets out the Westminster Government’s aims for tackling and reducing cardiovascular disease, as well as setting out the care and support that heart patients should receive.

The British Heart Foundation working together with over 40 other charities worked to infl uence this strategy by producing a report ‘Tackling Cardiovascular Disease: Priorities for the Outcomes Strategy’ – much of which was adopted in the Government’s fi nal publication.

We will continue working to ensure that the Strategy is adopted by the relevant bodies in the new commissioning landscape and to make sure that it is translated into action on the ground.

If you would like to fi nd out more information about the campaigns of the British Heart Foundation please bhf.org.uk/campaigns

New Resources update Pedometer challenge pack

The new Health at Work pedometer challenge pack has got all the resources a workplace needs to set up a walking challenge at

work. This four-week team challenge is a fun and easy way for employees to improve their physical and mental health and create a positive team spirit.

G118/0213 New stop smoking booklet

If you want to stop smoking, this booklet can help. It provides practical tips for smokers who are thinking about giving up and helps you understand more about why you smoke and how you can stop smoking for good.

It explains the link between smoking and heart disease and discusses different approaches to quitting, with tips and activities to help you on your journey.

Healthy eating

Our popular healthy eating booklets Eating well G186/1112 and Cut down on salt G160/0213 have had a makeover. Containing clear sections to work through and even more top tips, practical ideas and case studies, they’re simpler and easier to use than ever.

The booklets can be ordered from our order line or downloaded as interactive PDFs (along with extra worksheets to help you).

Active Lifestyle

Our recently updated booklets help you understand why being active is so vital for your heart health. They offer practical information, tips and tools so you can make physical activity part of your daily routine. Find out how changing your habits can soon add up, whether it’s walking, housework or playing with your children. Order Get active, stay active G12/1212 and Put your heart into walking G26/0113 through our orderline.

G5 public catalogue

Our new catalogue for the general public details all the information we produce for people who want to know more about heart conditions and how to prevent them. It’s a comprehensive guide to BHF information for adults, including everything from prevention to treatment.

M116 catalogue for HCPs, health educators and promoters

“Our new catalogue has been specially created for healthcare practitioners, educators and health promoters. Including handy quick reference guides to help them fi nd what they need quickly, this comprehensive catalogue lists all the resources BHF produces for adults, along with the programmes BHF offer to help them talk to their patients and participants about issues around CHD prevention, heart conditions, and treatments’

You can order by calling the BHF Orderline on 0870 600 6566, or emailing orderline@bhf.org.uk. Or going on line to www.bhf.org.uk/publications.aspx

Healthy eating

Our popular healthy eating booklets Eating well G186/1112 and Cut down on salt G160/0213 have

88

NHS Improving Quality Set up on 1 April 2013, NHS Improving Quality (NHS IQ) works to improve health outcomes across England by providing improvement and change expertise.

NHS IQ is an evidence-based organisation that has taken on board the lessons of improvement history and is aligned to the current needs and challenges of the NHS. To deliver objectives its work focuses on addressing the priority areas set out in the NHS Outcomes Framework 2013/14:

1. Preventing people from dying prematurely

2. Enhancing quality of life for people with long term conditions

3. Helping people to recover from episodes of ill health or following injury

4. Ensuring that people have a positive experience of care

5. Treating and caring for people in a safe environment and protecting them from avoidable harm.

Based on this NHS IQ is delivering 10 key improvement programmes, and four programmes to develop improvement capacity and capability within the healthcare system.

Improvement programmesDomain 1: 1. NHS Health Check - a risk assessment available to all

eligible adults in England in primary care and community settings

2. Improved public awareness and early diagnosis3. GP engagement in the big killers (cancer, heart disease,

stroke, respiratory, liver disease)

Domain 2:4. Long term conditions evidence based tools 5. Day and night integrated person centred care pathways for

the frail elderly, mental health, dementia and end of life care (seven day services)

Domain 3:6. Optimising primary care, assessment and diagnosis,

enhanced recovery, reablement and rehabilitation for all scheduled and unscheduled care (seven day services)

7. Rural and remote review to improve access to care and support for those living in rural areas (including Accident and Emergency [A&E])

8. Children and young people’s transition to adulthood services

Domain 4:9. Experience of care – to ensure that it is central to

commissioning and care delivery

Domain 5:10. Safety design and application - developing a new improvement system for safety across the NHS

Capacity and capability programmes

11. Transformational capability building within Clinical Commissioning Groups

12. Capability building for primary healthcare providers

13. Transformational capability building within the NHS Commissioning Board

14. Whole system transformational capability building

NHS IQ constantly seeks to transparently measure and evaluate the impact of its work to ensure that it is delivering real improvements that make a signifi cant difference to the people using healthcare services.

Find out moreWeb: www.england.nhs.uk/nhsiqEmail: enquiries@nhsiq.nhs.ukTwitter: @NHSIQ Sarah Armstrong-KleinNHS Improving Quality

Department of Health newsCardiac Rehabilitation in EnglandThe CVD Outcomes Strategy1, which was commissioned by NHS England (previously known as the NHS Commissioning Board), has been published (hurrah!). The good news is that the new CVD strategy highlights cardiac rehabilitation (CR) as a key action in the coming years and sets out challenging ambitions to increase national average uptake in England to 65% and to deliver rehab much earlier. On the one hand this is great news for the BACPR however given uptake to CR has barely changed in the last fi ve years this ambition represents a major challenge for CR programmes.

Clinical Commissioning Groups (CCGs) and Commissioning support units (CSUs) will be held to account within the new Clinical Commissioning Group Outcomes Indicator Set (CCGOIS) (formerly known as the ‘Commissioning Outcomes Framework’ or ‘COF’). We are close (but not certain!) to securing CR within this new agenda for 2014. We will keep you up to date in future editions of Connect!Reference: 1. DH (2013). Cardiovascular Disease Outcomes Strategy: Improving outcomes for

people with or at risk of cardiovascular disease www.gov.uk/government/publications/improving-cardiovascular-disease-outcomes-strategy accessed May 2013.

Prof. Patrick Doherty

National Audit of Cardiac RehabilitationNew improved NACR updateHopefully by now you should be typing away on the NEW NACR. As you’ll have seen, the new system now collects data for the BACPR Standards and Commissioner reports and includes a number of other fi elds to ensure all the work your rehabilitation team does is properly recorded and can be reported to your managers and purchasers. You’ll have noticed the slicker, more comprehensive reports and tables on the completeness of data

9

News from our key affiliates

British Society for Heart Failure

Future courses and meetings include:

16th Annual Autumn Meeting - 28-29 November 2013Venue: Queen Elizabeth II Conference Centre, London

Heart Failure Day for Training and Revalidation - 20 March 2014Venue: Beardmore Hotel & Conference Centre, Glasgow

Heart Failure Nurse Study Day - 21 March 2014Venue: Beardmore Hotel & Conference Centre, Glasgow

For further information see: http://www.bsh.org.uk/

British Association for Nursing in Cardiovascular Care (BANCC)At the end of March BANCC co-hosted with the Council on Cardiovascular Nursing and Allied Professions (CCNAP), part of the European Society of Cardiology (ESC), a very successful conference, EuroHealthCare. This conference attracted over 400 delegates from all over Europe to the city of Glasgow. This provided a great opportunity for nurses and allied professionals from many countries around the world to share expertise and knowledge and to network with each other. The conference also included a Pre-Conference Master Class on how to get your work in print.

Amongst other things, an example of anecdotal feedback included:

“The master class on the Thursday evening was excellent. For me the experience of presenting my MSc as a poster presentation was extremely valuable as it attracted a great deal of discussion and interest.”

On Friday 12 April, BANCC President elect Jacqueline Hunt was part of a select group of people invited by the RCN to meet and explore the potential for a Cardiovascular Nurses’ network. The consensus reached was that the RCN would act as a virtual vehicle to collaborate and link the CVD bodies together. This will be of benefit to all Specialist Cardiac Nurses and as the RCN have 410,000 members, an excellent channel for collaboration. At the meeting Jacqui emphasised the benefit of BANCC involvement due to its rich resource of Specialist Cardiac Nurse members. JP Nolan from the RCN is to identify the next steps.

Suzy Wood British Association for Nursing in Cardiovascular Care

Heart Care Partnership becomes Cardiovascular Care Partnership (CCP)CCP (UK) were delighted to hold their second full day’s programme at the BCS conference 2013 where the theme was the importance of the patient voice.

The topics included patient empowerment in the outcomes strategy, listening to the patient through the multidisciplinary team and the international GUCH movement and their voice.

Speakers included Dr Anthony Rudd, Professor Huon Gray, Dr Jane Flint and Jenni Jones.

so you can confirm that your data is accurate and have access to it whenever you need it. There are more improvements to come, including linking to the Office for National Statistics (ONS) mortality register.

THANK YOU to all those rehab teams who gave their time to help us design the new dataset items and who tested and retested the database through the pilot process. We hope you will agree that this has ensured that this new version is vastly improved and worth the wait! As always, we welcome further feedback. If you’ve not received the new training manuals and questionnaire pack or want some training or phone support please let Nerina know.

IMPORTING DATA For those of you who use another audit or clinical management system but would be interested in importing your data into NACR please get in touch. Importing is now far easier to set up now so your IT support might be more keen to get involved!

If you want to learn more about the new NACR please contact Nerina. (nerina.onion@york.ac.uk)

Corinna Petre for the NACR Team

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A national accreditation scheme – the future for CR programmes in the UK?Dr Nayan Kalnad, Senior Commercial Trial Manager, Janssen Healthcare Innovation*

With less than half (44%) of eligible patients in England, Wales and Northern Ireland taking part in cardiac rehabilitation (CR) programmes,1 a new solution to increase uptake and adherence is necessary. The myriad benefi ts of CR are now well-evidenced; from increased exercise capacity, improved risk factor profi le and enhanced quality of life to reduced morbidity and mortality rates.2,3,4 What’s more, CR programmes have also proven cost-effective.4 Despite this, patient recruitment and retention rates across the UK are low, owing to numerous barriers including sub-optimal referral rates and access issues.5 To help combat this and drive improved outcomes for patients with cardiovascular disease, the BACPR is currently working with numerous stakeholders, including Janssen Healthcare Innovation, to develop a national accreditation scheme for CR programmes in the UK. Janssen Healthcare Innovation is committed to delivering an integrated approach to healthcare and is working in collaboration with partners to improve care quality and patient outcomes, particularly in areas of signifi cant need such as cardiology.

The BACPR recently agreed that a UK national accreditation scheme should aim to:

•SignalessentialstandardsofcaredeliveryinCR;

•Promoteexcellenceandrewardimprovementinthedeliveryof CR;

•Provideinformationforpatients(theircaregivers/family)onthe level of service they can expect from a CR programme;

•Gainrecognitionbypayors/commissionersforhavingattained key performance indicators; and

•JustifythelevelofrequiredresourcetodeliverthelevelofCR advised by the scheme.

In 2012, the BACPR took its fi rst steps towards this with the development of the Cardiovascular Disease Prevention and Rehabilitation Standards of Care and Core Competents,3 which follow from the NICE Commissioning Cardiac Rehabilitation Guidelines.6 Designed to identify and spread best practice, these Standards of Care also rely on emerging data from the National Audit of Cardiac Rehabilitation (NACR) to offer a comprehensive guide to quality indicators in CR programmes.

In the previous issue of Connect, Corinna Petre, NACR Project Manager, and Professor Patrick Doherty, NACR Clinical Lead, argued that as “the National Service Framework for Coronary Heart Disease is now ten years old ... it is essential we draw on a new standard for which to evaluate the effectiveness and progression of cardiac rehabilitation each year.” A national accreditation scheme is being seen as the natural progression to

bridge the gap between the existing national guidelines, clinical data and standards of care.

While establishing a new accreditation model in the UK need not be resource intensive given the raft of existing resources and expertise, there is much to be learnt from peers across the pond. In the United States (US), a national accreditation scheme for CR programmes already exists. This scheme identifi es and mentors high quality programmes to help them achieve evidence-based core components, and provides certifi cation for those meeting these standards. It aims to promote expert opinion and best practice in CR, and to enhance patient and practitioner confi dence by upholding the highest standards of service delivery. Established in 1998, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) accreditation scheme currently has 1,669 Certifi ed Programs and 30 accreditation volunteers. In 2013, they received 574 applications alone.

To achieve accreditation, programmes are measured against essential standards (elements) which are aligned with current research, core competencies, core components and expert opinion. These standards are reviewed and updated annually in response to new research linked to optimal CR programmes and patient outcomes. This evolving set of required elements means that patient outcomes are always at the heart of the accreditation process. Programmes, however, are only required to apply for re-accreditation every three years to ensure the process is not overly resource intensive, but are expected to review the required elements on an annual basis.

According to Bonnie Anderson, Director – Programme Certifi cation AACVPR, accreditation is now seen as the gold standard for CR programmes in the US. Results are emerging that demonstrate its value; not least the fact that accreditation is becoming a prerequisite for commissioning. Indeed, a key challenge that faced the US scheme in the early stages, according to Ms Anderson, was to ensure CR programmes kept the delivery of a quality service for patients as the central goal of accreditation, rather than encouraging them to arbitrarily implement base levels standards in order to be certifi ed. An ongoing initiative is the implementation of

the AACVPR Registry, which is designed to collect patient outcome data to further validate the required elements of the certifi cation process.

To mitigate this problem, the AACVPR accreditation scheme offers mentoring and remediation for CR programmes that wish to achieve certifi cation. Ms Anderson says this approach could be benefi cial for the UK accreditation scheme: “The guidance and mentoring we provide helps the programmes to achieve accreditation in a way that best blends the elements required for reimbursement, the evidence surrounding positive

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ICCPR NEWSBACPR and CACR Representatives Attend International Development Meetings in Paris

patient outcomes, and the demographics and needs of the patients using their service. This type of collaborative approach is key to raising the credibility, consistency and quality of CR programmes.”

In the new NHS there is an opportunity not just to trial new ways of identifying and recognising outstanding CR programmes but also, by creating a framework for a national accreditation scheme, to raise standards and seed best practice across cardiac care. A team led by Gill Furze, Professor in Adult Nursing and Health Care, is currently working to develop a blueprint for a national CR accreditation scheme in the UK.

*Janssen Healthcare Innovation is an entrepreneurial team within Janssen Research and Development. References:1 National Audit of Cardiac Rehabilitation. 2012 National Audit of Cardiac

Rehabilitation. London: National Audit of Cardiac Rehabilitation. 2 Maines T. Y., et al. Effects of cardiac rehabilitation and exercise

programs on exercise capacity, coronary risk factors, behavior, and quality of life in patients with coronary artery disease. South Med J. 1997 Jan; 90(1): 43–49.

3 Lawler PR, Filion KB, Eisenberg MJ. Effi cacy of exercise-based cardiac rehabilitation post-myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. Am Heart J Oct 2011; 162: 571-584.

4 British Association for Cardiavascular Prevention and Rehabilitation. 2012. The BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation 2012 (2nd Edition). London: British Association for Cardiovascular Prevention and Rehabilitation.

5 National Institute for Health and Care Excellence. NICE: Cardiac rehabilitation services. Available at: http://publications.nice.org.uk/cardiac-rehabilitation-services-cmg40/42-maximising-participation-and-completion. Last Accessed: May 2013

6 National Institute for Health and Care Excellence. Commissioning cardiac rehabilitation services. 2011. London: National Institute for Health and Care Excellence.

ICCPR Chair Dr. John Buckley (BACPR) and ICCPR Secretary-Treasurer Dr. Sherry Grace (CACR) attended meetings in Paris on the 11th and 12th of January, 2013, with board members from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), the World Heart Federation (WHF) CEO, and the World Health Organization (WHO) head of Non-Communicable Diseases. The aim was to discuss a Global Forum on cardiovascular disease in conjunction with the EuroPRevent meeting scheduled for April this year in Rome. Discussion was based around developing an action plan for the WHO’s 25 by 25 goal – to reduce premature deaths from non-communicable diseases by 25% by the year 2025. The ICCPR will be teleconferencing with the President of EACPR and the Chair of their Reach Out Task Force to discuss development of an action plan and how the ICCPR can contribute in the area of secondary prevention and cardiac rehabilitation (CR).

Dr. Buckley and Dr. Grace also had opportunities to meet with the EACPR nuclei groups in CR and sports cardiology to explore ways of working together in the future. The ICCPR International Charter has now been published in the Journal of Cardiopulmonary Rehabilitation and Prevention. In December 2012, the ICCPR Council was offi cially formed with the initial coming together of 13 cardiovascular prevention and rehabilitation associations from around the world.

They have set out a terms-of-reference, and elected an executive committee: Chair, Secretary and Vice-Chair. Dr. John Buckley (Chair) and Dr. Sherry Grace (Secretary) are joined by Vice- Chair, Dr. Aashish Contractor, who represents India’s National Society for the Prevention of Heart Disease and Rehabilitation. Many BACPR members will know Aashish Contractor who has presented at BACPR and British Cardiac Society Conferences

on considerations for South Asians in CR. He also holds the accolade of being the personal rehabilitation physician to the Prime Minister of India.

To get the ICCPR going, each member Association has agreed to pay a relatively small membership fee ($200 US Dollars) to cover the cost of teleconferences and the fee required to establish themselves as an offi cial sub-group of the WHF.

The ICCPR is putting plans together to host a symposium at the 2014 World Congress of Cardiology in Melbourne, Australia. The focus of this symposium will be promotion and adoption of cardiovascular prevention and rehabilitation programs in low and middle-income countries.

Dr. John Buckley (BACPR), Chair of the ICCPR & Dr. Sherry Grace (CACR) Secretary-Treasurer take a short break from the international meetings in Paris.

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New scientific publications to inform your practiceIn the last issue of Connect (January 2013), we highlighted Sandercock et al’s (2012) study which found gross ‘under-dosing’ in exercise intervention within CR programmes in the UK and urged members to review the exercise component as it is currently practiced within your programme as a matter of urgency.

Take home message – measurement of your outcomes and comparison then between what you achieve and what has been achieved in the evidence showing benefit is essential

In May 2013 HEART published further editorials regarding “The Emperor” and whether he (or cardiac rehabilitation in this case) is properly dressed in the UK. We recommend members to read these editorials in order to be able to be able to articulate the benefits of cardiac rehabilitation and call for proper investment.

Given the major advances in cardiology the influence that cardiac rehabilitation post myocardial infarction or revascularisation may have on mortality is likely to reduce. Your emphasis in discussions should relate to the benefits of influencing patient well-being, especially in light of the growing number of surviving individuals living longer with the burden of cardiovascular disease.

Improved survival coupled with an ageing population is leading to a growing number of people developing heart failure and other chronic diseases. The BACPR Standards and Core Components align to practitioners positioned to deliver evidence-based chronic disease management programmes.

The recent attention to cardiac rehabilitation in HEART is welcomed. Where programmes are under-resourced it provides an opportunity to call for their programmes to be properly funded as a cost-effective means and obligatory element to any modern cardiology or vascular health care service.

Take home message: To provide evidence-based doses of CR requires programmes to be properly funded.

In the bigger picture of developing our services at a national level we need tighter control of service audit (e.g. through NACR), not only to ensure these standards and core components are being met but to demonstrate that improved practice, clinical effectiveness and health outcomes have been achieved.

Take home message: Audit and evaluation are vital in every centre but we also need to work together in ensuring high quality care at a national level by contributing to the National Audit for Cardiac Rehabilitation.

Please visit www.bacpr.com for the full version of the BACPR Standards and Core Components.

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. Estruch et al. New England Journal Medicine; Published online 25 February 2013:

http://www.nejm.org/doi/full/10.1056/NEJMoa1200303

This landmark randomised controlled trial in primary prevention concerning individuals without cardiovascular disease though at high cardiovascular risk now highlights the importance of delivering Mediterranean dietary advice to this group of patients, as well continuing to do so in secondary prevention to reduce major cardiovascular events. In this latest multicentre trial in Spain,

participants who were advised to follow a Mediterranean dietary pattern, and who also were supplemented

with either extra virgin olive oil or mixed nuts, experienced a 30% reduction in the

combined end point of stroke, MI or cardiovascular death when compared to those in the control group. The trial, of which over half the study population were women, is the first large randomised controlled trial in primary prevention concerning a Mediterranean dietary intervention.

Although NICE, in its partial update of guideline CG48, MI secondary prevention

(2007) due to be published in November this year, is reviewing its recommendations

on omega 3 polyunsaturated fatty acid intake, its Grade A recommendation to offer Mediterranean dietary

advice to this population is remaining firmly intact. Compelling randomised controlled trial evidence for the benefit of this came from the Lyon Heart Study where survivors of an MI advised to follow a Mediterranean dietary pattern experienced a large reduction in events compared with the control group (Circulation. 1999;99:779-785).

We recommend the use of the interviewer led 14Q validated Mediterranean diet score (MDS) developed by the PREDIMED team as an audit tool in cardiovascular rehabilitation and prevention services. This should be done at baseline when assessing patients’ dietary intake, at the end of the programme and at 1 year. Increasingly cardiac rehabilitation programmes in the UK and Europe are using this as an audit tool in relation to secondary prevention dietary advice adherence.

Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention A Prospective Cohort Study of 31 546 High-Risk Individuals From 40 Countries Deghan, M., Mente, A., Teo, K et al. (2012). Circulation 126: 2705-271

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More recent evidence for the benefit of improved diet quality in those with established cardiovascular disease comes from an international study conducted by the Population Research Institute, Hamilton, Ontario in Canada. Looking at individuals already on optimal drug therapies for cardiovascular disease in a study of over 31 000 individuals with CVD or diabetes over nearly 5 years, Mashid Dehghan and colleagues demonstrated that a higher quality diet was linked with a reduced risk of recurrent CVD events among people ≥55 years of age with CVD or diabetes mellitus. The authors recommended that continuing to “highlight the importance of healthy eating by health professionals would substantially reduce CVD recurrence and save lives globally”.

Early referral to cardiac rehabilitation significantly increases the likelihood of attendanceAn Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation

By Pack et al (December 2012) Circulation: doi: 10.1161/CIRCULATIONAHA.112.121996

This randomised, single-blind, controlled trial in the United States found that enrolling patients into cardiac rehabilitation 10 days post discharge, compared with the standard average time of 35 days, has a significant effect on patient attendance at the orientation (first) session of the rehabilitation programme.

148 nonsurgical (including 50% NSTEMI and 30% PCI without MI) patients (average age 60±12 years, 56% male and 49% black) were randomised to early enrolment (10 days) or standard (35 days). Attendance rates at the orientation session were reported as 77% (57/74) for early enrollers and 59% (44/74) for standard. This translated into an 18% absolute and 56% relative improvement (relative risk, 1.56; 95% CI, 1.03-2.37; P=0.022).

This study supports the BACPR’s recommendation of the commencement of cardiac rehabilitation within two weeks.

Prescribing 1g daily Omega-3-acid ethyl esters in patients Post-MI to prevent unnecessary death. By Julian Halcox, Professor of Cardiology

Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine Director Cardiovascular Research Group Cymru

Over a decade after the publication of GISSI-P, my expert colleagues from Cardiff University and I have conducted a study from within a pool of over 11 million UK patients held within the General Practice Research Database between 2002 and 2011.

The goal of this study was to evaluate the impact of the use of licensed, purified Omega-3 fatty acids (Omacor®) on all-cause mortality after a heart attack in a contemporary UK practice setting, in order to examine whether the impressive outcomes observed in the GISSI-P study were still relevant for patients treated according to current evidence-based strategies.

The study design was a retrospective, matched, cohort study. The aim of which was to compare survival in people who had received Omacor® within 90 days of their first heart attack versus those who had not.

These included 2,466 who had received a gram a day of Omacor® within 90 days of their first heart attack, who were matched in a 1:4 ratio to similar patients who had not received the treatment with Omega-3 fatty acids after their first MI.

The vast majority of these subjects were receiving appropriate concurrent treatment with lipid lowering drugs, anti-hypertensives including beta-blockers and ACE inhibitors, and anti-platelet agents.

The outcome analysis showed that age, smoking, comorbidity, diabetes and socio-economic status were all associated with all-cause mortality much as expected. Similarly, the use of anti-platelet drugs, statins and anti-hypertensive therapies were also associated with lower mortality.

The primary outcome analysis demonstrated that initiation of Omacor® within 90 days of the first MI was associated with a further reduction in all-cause mortality of 21.8% (Absolute risk reduction (ARR) 3.2%). This mortality reduction was remarkably consistent with the benefits of Omacor on survival that were observed in the GISSI-P trial, even after taking into account key determinants of risk including the use of various secondary prevention therapies, age, gender, socio-economic status, smoking, diabetes and the comorbidity index.

The consistent benefit of Omacor® on all cause mortality also remained apparent after specifically taking into consideration the use of contemporary treatment strategies including dual anti-platelet therapy, high potency statins and achievement of aggressive lipid targets.

Therefore, Omacor® is associated with a beneficial impact on survival, which is independent of important clinical parameters and the use of contemporary evidence-based treatments.

The NICE clinical guidance standard 48 states that for patients who have had suffered a myocardial infarction within the past 3 months who are not achieving a dietary intake of at least 7 grams per week of Omega-3 fatty acids, one should consider prescribing at least a 1 gram daily dose of an Omega-3-acid ethyl ester treatment which is licensed for secondary prevention post MI. The findings from our study fully endorse this recommendation for current practice.

Further information: Poole, CD., Halcox JP, Jenkins-Jones, S. et al. (2013). Omega-3 Fatty acids and mortality outcome in patients with and without type 2 diabetes after myocardial infarction: a retrospective, matched-cohort study. Clin Ther. 2013 Jan;35:40-51 NICE (2007). MI: secondary prevention Secondary prevention in primary and secondary care for patients following a myocardial infarction. London, NICE.

1415

BACPR – Exercise Professionals Group ReportThere is plenty going on in the world of exercise related to cardiac rehabilitation. Read on for more details:

BACPR Exercise Instructor Network

Exercise Professionals Group Spring Study Day Heart Failure: Meeting the Challenges in Physical Activity and Exercise

The BACPR EPG Study Day conference 2013 focussed on meeting the challenges in Heart Failure in relation to physical activity and exercise.

The reoccurring theme of the day was individualisation.

The conference was presented by the following eminent experts in the management of Heart Failure: Professor Peter Brubaker, Dr Klaus Witte, Paul Stern, Samantha Breen, Mark Campbell, Laura Burgess, Rosalind Leslie, Louise Beale and Adrian Roose.

Key messages from this study day were…

1. Brubaker - HF action trial - biggest trial ever done in CHF (Congestive Heart Failure) - a dose response effect does exists for exercise in HF. Those who do more (up to 7 MET hrs per week) have significantly better outcome. HF Action also revealed that the behavioural challenge to getting CHF patients to adhere to participating in moderate intensity exercise is seemingly greater than more typical groups attending CR.

2. Brubaker - Current research showing that properly managed high intensity (HIIT) exercise is more beneficial than moderate intensity continuous. More research is needed looking at long term benefits. Considering the above behavioural challenges, in practical terms this may all be too difficult to deliver, achieve and sustain for typical CHF patients. Caution should be taken when considering using HIIT.

3. Witte - the addition of a Beta Blocker in CHF patients preserves maximal capacity rather than impairing maximal exercise tolerance. Beta Blockers do not make patients breathless and should not be stopped to ameliorate this symptom. Breathlessness is a manifestation of the disease rather than Beta Blocker induced

4. Burgess and others - international guidelines for exercise in Heart Failure are predominantly based on trials conducted in a demographic that is incomparable to real life practice. There is a need for guidelines to suit the ‘real’ Heart Failure population

If you are interested in reading about the evidence behind these messages the presentations are available to download in the members only area of the BACPR website (see conference presentations section).

Brian Begg BACPR-EPG Council Liaison

BACPR working with Resus UK to update Resus Guidelines for Cardiac Rehabilitation

A working group has made recommendations to update the joint statement by the Resuscitation Council (UK) and the British Association for Cardiac Rehabilitation (BACR) published in 2008.

The recommended update covers both early CR (Phase III) and long term management (Phase IV) and therefore replaces both the Joint Statement on Resuscitation Training and Facilities (BACR and the Resuscitation Council (UK), November 2008 and the Supplementary Statement on Automated External Defibrillators (AEDs) and Exercise, September 2009.

The below working party has updated the 2008/09 statements to become a single statement, the content of which has been agreed by BACPR council. The update has been forwarded to the Chair of The Resuscitation Council UK for comment. Once agreement has been reached with the Resuscitation Council (UK) and BACPR, the membership will be informed via Connect and the Joint Statement 2013 will be published on the BACPR website.

Working party members:

Samantha Breen, Chair BACPR-EPG

Kathryn Carver, Specialist nurse BACPR Council

Sally Hinton, Director of BACPR Education

The BACPR Exercise Instructors’ Network (EIN) held their AGM at the EPG Spring study day on 10th May. Voting took place to elect new EIN committee members who will serve for the next 2 years. They are as follows:

Chair – Susan WhyteVice Chair – Lorna PreeceSecretary & Communications – Marie Toms

Treasurer – Juliet Stevenson (Temporary)PR Officer – Tim GroveLead Workshop Coordinator – Michelle JermyWorkshop Coordinators – Terri Bryant & Des Tomlinson

The EIN would still like to appoint a new Treasurer and anyone who is interested in taking on the role should contact Susan Whyte at susanmwhyte@gmail.com

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Introducing Frances Driver, Chairperson to the Cardiac Rehabilitation Interest Group in Scotland

I have worked in the field of Cardiology for the past 30 years with a keen interest in the development of Cardiac Rehabilitation Services across Lothian. I was appointed Cardiology Nurse Consultant for NHS Lothian in 2005 and hold a clinical case load within the Rapid Access Chest Pain Clinic seeing approximately 400 patients per year. Currently I am the lead nurse for Cardiac Rehabilitation Services within Lothian and manage a small team of Cardiac Rehabilitation Specialist Nurses across three sites.

I have been actively involved at a national level with the development, implementation and evaluation of guidelines and standards, subsequently leading to the production of outcome activity data across Scotland. I am a key member of the Scottish cardiac rehabilitation steering group and very much aware of the need to put effective systems in place in order to produce good outcome data to ensure what we do is safe, effective and patient centred care meeting the needs of both the service and its users. As part of my role I have had the opportunity in developing good and effective links with Chest Heart & Stroke Scotland and the British Heart Foundation who have been fundamental in taking forward key initiatives.

My involvement with the Cardiac Rehabilitation Interest Group for Scotland (CRIGS) has been two-fold. Initially being an active member then proceeding to taking over the role of Chair.

Supported by Chest Heart & Stroke Scotland, CRIGS was formed in 1990 with the aim to stop the process of “reinventing the wheel” for cardiac rehabilitation in Scotland. In the form of formal information study days and workshops, the group provided the opportunity to share information and for members to learn from each other’s experiences in a multi-disciplinary setting.

Fundamentally the ethos and values of the group have remained unchanged over the years however there is much more of an emphasis on being a resource and research-base for cardiac rehabilitation. The group strives to promote education forums for networking and sharing evidence-based practice, new initiatives and ideas to strengthen multi-disciplinary links in cardiac rehabilitation across Scotland thus leading to an increase in profile. CRIGS has welcomed the re introduction of its links to BACPR which hopefully provides the opportunity to share information and outcome data across the Border.

The main priority for CRIGS over the next few years is to support its members in the development of services in light of the recent publication of the BACPR and the Health Improvement Quality Standards in Scotland. A challenge for us all is to include more cardiac patients into our services without any extra resource and also to provide meaningful outcome data to prove what we actually do does make a difference. This can be seen as an exciting time for us in Scotland as it will challenge us to evaluate what we currently provide and redesign services which will be fit for purpose in today’s healthcare. The forthcoming conference in November will provide an ideal opportunity to allow members not only to network but also have the chance to hear key individuals discuss new initiatives and research in the field of cardiac rehabilitation.

Frances Divers Cardiology Nurse Consultant NHS Lothian Chairperson to CRIGS

Workshop Update It has been a busy year for the EIN Committee who have organised four workshops on ‘Obesity, Physical Activity and CVD’.

Murray Allan designed and delivered the workshops which took place in England and Dr. Alison Kirk delivered in Scotland.

Some comments from these workshops include:

“An excellent update/refresher on the subject. Great to have definitive guidelines and information to use in practice.”

“I enjoyed the day. It was a good way of refreshing and learning as well as networking with other colleagues.”

“I found the overview of obesity and the links with diabetes with the levels of training most useful.”

“The session planning and in particular changing behaviour was good. I will use it to improve the motivation of my customers.”

“The input from different disciplines of health professionals present at the workshop was useful.”

The EIN Committee are working towards developing more relevant workshops for 2013/2014 and are using suggestions given at the workshops to do this.

The workshops are made available to help you keep up to date with your practice as well as present a great networking opportunity.

Please consider attending the next one that comes to your area or perhaps even offering to host a workshop. If you are interested please contact Michelle Jermy, Lead Workshop Coordinator at michellejermy@hotmail.com

Marie TomsEIN Secretary and Communications

BACPR Exercise Instructor Qualification Revalidation now online

16

News from the regionsNorthern IrelandThe Northern Ireland Service Framework for Cardiovascular Health and Wellbeing was originally launched in 2009. Following its first three years of implementation, which has led to a number of improvements in the quality of care the people in Northern Ireland receive, the Framework has been subjected to a fundamental review.

The revised Framework for Cardiovascular Health & Wellbeing includes 43 standards and is currently out to Public Consultation. Each standard is supported by levels of performance to be achieved over three years and the revised framework will continue to be subject to regular review.

Within the framework the proposed overarching standard relating to the provision of Cardiac Rehabilitation in Northern Ireland is:

All patients identified as requiring cardiac rehabilitation, in line with the regional guidelines, should have their rehabilitation delivered by a specialist cardiac rehabilitation multi-disciplinary team

Related performance indicators and anticipated performance levels include

Percentage of patients referred to cardiac rehabilitation that receive Phase 1

Percentage of eligible patients referred to cardiac rehabilitation that receive Phase 2

Percentage of eligible patients invited to join a Phase 3 programme.

Percentage of patients invited to join Phase 3 that commence the programme.

Percentage of patients accepting referral to a structured community exercise programme (Phase 4)

It was decided regionally to continue to audit information on the phases as opposed to stages as this information has been collated in Northern Ireland over the previous three years and is therefore easier to determine if targets are being achieved.

With regards to a regional primary PCI service model for patients with a diagnosis of ST elevation Myocardial Infarction, The Northern Ireland Programme for Government (PfG) 2011-2015 includes a commitment to the development of such a service by 2014/15.

The delivery of a regional service will provide all those involved in the delivery of cardiac rehabilitation with the opportunity

to work together across the region to review current cardiac rehabilitation models and pathways to further determine what meets the needs of those who have had a primary PCI.

Lynne Charlton Cardiac Network Co-ordinator Performance Management & Service Improvement Directorate Health & Social Care Board

Scotland“The number of specialist heart failure nurses is falling as the number of patients with heart failure rises”The report from the Scottish Heart Failure Nurses Forum (SHFNF) published in March this year reviewed heart failure nurse services across Scotland.

Suzanne Bell, chair of the SHFNF and one of the authors of the report, says: ‘Heart failure is a life-limiting condition and people can live with disabling and isolating symptoms for many years. While fewer people are dying from cardiac conditions, more people are living with heart failure, in fact, almost 94,000 in Scotland. Specialist heart failure nurses have the skills, training and expertise to manage the complexities of this condition, in a highly cost-effective way.

They are valued by both patients and carers living with heart failure in Scotland. Along with the other members of the heart failure services they should be supported so that their vital work can be sustained and improved in the coming years to meet the growing needs of the heart failure population.’

The report also highlights that there is a growing body of evidence to support the inclusion of patients with heart failure in cardiac rehabilitation programmes and a recent Scottish study found significant improvement in fitness and walking ability within a hospital based programme. A key recommendation is to ‘Implement the Healthcare Improvement Scotland 2011 recommendations on the provision of cardiac rehabilitation for focus on those heart failure services which have not previously had access to a cardiac rehabilitation service and increase provision in areas where the current service is inadequate.

For further information: Louise Peardon, Ordinary Council Officer (Nurse) &SHFNF Secretary

See here for the report: Review of Specialist Heart Failure Nurse Services in Scotland 2013. www.chss.org.uk/shfnf.

WalesNational Exercise Referral Scheme The National Exercise Referral Scheme (NERS) is a Welsh Government (WG) funded scheme which has been in development since 2007 to standardise exercise referral opportunities across all 22 local authorities and it is the only National Exercise referral Scheme in the UK.

A randomised controlled trial was commissioned to determine the scheme’s effectiveness in increasing participation in physical activity, improving health in patients at risk of chronic disease and providing potential savings to the health service. The main findings of the evaluation were:

•Allparticipantsintheschemehadhigherlevels of physical activity than those in the control group, with this difference being significant for those patients referred for coronary heart disease risk factors.

•Therewerepositiveeffectsondepressionand anxiety, particularly in those referred wholly or partially for mental health reasons.

•Theeconomicevaluationdemonstrateda cost per QALY of £12,111, which is well within the NICE threshold for cost effectiveness of £20,000 - £30,000, and for those who adhere to the full programme the scheme is likely to be marginally cost saving (£-367 per QALY).

Full results http://wales.gov.uk/about/aboutresearch/social/latestresearch/exercise/?lang=en

It is an evidenced based national programme that provides an opportunity for patients to access a high quality supervised exercise programme, with the aim of improving health and wellbeing through long-term participation in physical activity.

Following the evaluation the National Coordinator has gone on to develop NERS into two distinct but inter-related elements:

•ExerciseProfessionalsthatareregisteredat Level 3 of Register of Exercise

17

After qualifying as a yoga teacher, I became interested in the benefi ts that yoga could offer the cardiac patient. I discovered that in America, several health insurance companies are now funding yoga for cardiac rehabilitation, most notably, Medicare, the government health insurance programme for Americans 65 and older.

I applied for and was awarded the 2012 Travel Award to train as a Cardiac Medical Yoga Teacher. I travelled to the Sivananda Yoga Ashram on Paradise Island, Nassau (Bahamas) to complete the 77 hour training. The course was run over 6 days and was tutored by Dr. Mala Cunningham, a counselling psychologist and yoga teacher from The Virginia University Heart Centre. We were a small group of just 4 delegates from USA, Canada, Israel and the UK.

During the course, I learned how to adapt and teach a yoga class to the cardiac patient. In the west, our yoga classes have become very focused on the asana practice (physical postures), yet yoga is so much more than contorting the body into shapes that resemble pretzels and I am as guilty as any for dedicating much of my yoga practice to the physical postures. This course focused heavily on the breath (pranayama) and introducing appropriate breathing techniques and practices to the cardiac patient. We also worked on effectively teaching relaxation and meditation. From my experience working in cardiac rehab in the UK, I fi nd many patients fi nd the relaxation component of the class very diffi cult, and during the course, we were taught simple strategies to help patients to effectively turn their focus inward. The ability to recognise how our emotions/feelings may be infl uencing/affecting our health, wellbeing and also cardiac recovery was also addressed and the power the mind has over the body demonstrated with simple visualisations. These were very basic and perfect to use with patients who are sceptical about practising more holistic forms of mind-body exercise and

have pre-conceptions about yoga such as associating it with being a hippy! Leading on from this, the introduction of the more ‘controversial’ practices such as chanting was also discussed and consideration taken about whether it is appropriate to use Sanskrit terminology to describe the poses e.g. Surya Namaskar to describe the Sun Salutation sequence.

Naturally, the programme included postures and these were heavily modifi ed. Various

class formats were introduced which were: chair-based, chair-assisted, wall assisted and modifi ed standing/fl oor. All the postures were gentle, simple, and easy to follow movements which I could really envisage heart patients undertaking.

Although it was wonderful to visit the Bahamas, it was not my fi rst choice of venue and I had hoped to complete the training in Virginia, USA and undertake fi eld trips to The Virginia Heart Centre to see classes in action. The Sivananda Ashram is an amazing place, but not a conducive learning environment due to the mandatory schedule all guests must follow. This included waking at 5:30am to attend 2 hours of Satsang before the course started, being limited to 2 meals a day, and having to attend a further 2 hours of Satsang from 8pm-10pm. There was actually very little time left to complete the homework. That said, I really enjoyed attending Satsang twice daily and felt I benefi tted from the 20 minutes of silent meditation and 20 minutes of chanting at each.

Since my return, I have been practising to get up to scratch in preparation to teach classes locally. I have been busy writing a feature for ‘Yoga & Health’ magazine and I am putting a piece together for The British Heart Foundation.

Marie Toms is an Assistant Practitioner Physiotherapist at Papworth Hospital NHS Foundation Trust. If you have any questions or would like further information, she can be contacted at marie.toms@nhs.net

Members news – Travel AwardBACPR Travel Award 2012 Report - Cardiac Yoga ® Teacher Training in The Bahamas

yoga such as associating it with being a hippy! Leading on from this, the introduction of the more ‘controversial’ practices such as chanting was also discussed and consideration taken about whether it is appropriate to use Sanskrit terminology to describe the poses e.g. Surya Namaskar to describe the Sun Salutation sequence.

Professionals (REPs) provide ‘generic’ NERS sessions for ‘low risk’ population groups that need some support to increase fi tness and reduce general risks of developing chronic conditions. (16 week programme)

• Level 4 (REPs) Exercise Professionals provide more specialist NERS sessions for population groups deemed to be ‘higher risk’ and needing to undertake tailored exercise sessions as part of their rehabilitation following an intervention by the NHS or to manage a chronic condition and use exercise as a means of secondary prevention. (16-48 week programme)

New pathways have been developed in partnership with condition specifi c policy leads from the Chartered Society of Physiotherapy to meet the new level 4 National Occupational Standards for Exercise Professionals to work with clients with chronic conditions.

Accredited training for chronic conditions has already been provided on;• Phase IV Cardiac Rehabilitation

Instructor• Level 4 Respiratory Disease Instructor • Level 4 Postural Stability Instructor

(Falls Prevention) • Level 4 Back Care• Level 4 Exercise After Stroke • Level 4 Mental Health• Level 4 Obesity and Diabetes• Level 4 Cancer

In addition to the accredited level 4 training many BACPR Phase IV Instructors have completed the Heart Failure CPD and incorporate these referrals where appropriate in either Phase IV Cardiac, Respiratory or where balance and gait are compromised into the evidenced based Postural Stability and Balance programmes.

For further information please contact Jeannie.Wyattwilliams@wlga.gov.uk Website: www.wlga.gov.uk/ners

Marie pictured with Mala Cunningham and K.Krishnan Namboodiri

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The BACPR Education programme is well established across the UK and over the past year there have been over 30 short courses delivered and nine exercise instructor training courses. All the courses within the programme are approved by the British Cardiovascular Society (BCS) and BACPR is a registered SkillsActive/Register of Exercise Professionals (REPs) training provider with all courses holding REPs CPD points.

On line revalidation of the BACPR Exercise instructor qualifi cation has been successfully launched and is available to the 2500 qualifi ed instructors that hold the BACPR qualifi cation.

Further exciting e-learning projects are planned for the next few months along with improvements to the Resources page of the website.

My sincerest thanks to the excellent BACPR tutors who ensure the quality of our education is of the highest standard and to Vivienne Stockley and Penny Hudson for their hard work and dedication in administering the education offi ce.

Hope to see you at one of our courses in the near future and at the 2013 annual conference which marks our 20 year anniversary.

Sally HintonEducation Director

Recent course reviews

BACPR Physical Activity and Exercise in Management Part 1 : Principles and Practicalities – March 2013

I attended this course in order to become more familiar with the principles and practice of Cardiac Rehabilitation. As a Physiotherapy Lecturer/Practitioner in Neurological Physiotherapy I felt that I needed to increase my knowledge and skills in this area in order to fully understand how to challenge my neurological patients. Although I have not directly managed a cardiac rehabilitation class this was not a problem on the course. Both teachers were very good at explaining the underlying principles and practice of cardiac rehabilitation. The teaching mix of a physiotherapist and exercise professional was ideal.

My fellow delegates were from a mixture of backgrounds including physiotherapists, exercise professionals and nurses. There was plenty of small group working for us all to share our knowledge and experiences and this defi nitely added to the learning experience. The day was a good mix of theory and practice which I found extremely important. I felt the depth of theoretical knowledge and the amount of research evidence was extensive and provided me with the necessary information to explain the principles to undergraduate and postgraduate physiotherapy students. Having since completed the Part II course I now feel fully able to apply these principles to my neurological population and teach my students the importance of cardiovascular training in all

populations not just cardiac patients.

Nicola Clague-BakerPhysiotherapy Lecturer/Practitioner, University of Leicester

BACPR Dietary Approach to Managing CVD & Weight April, 2013

Various comments from the day from participants included:

“Picked up good tips on anthropometrics & dietary assessment.”

“Got some useful ‘sound bites’ and ‘easy explanations’ to use with patients.”

“Fat practical’s – simple but effective and I will use.”

“Great day to increase knowledge of diet and update skills to take back to work place.”

“A well-rounded course and interesting session.”

“Interesting day - good speakers with lots of practical experience to pass on.”

“Got some useful websites – like NHS Choices behind the headlines to help answer patients queries with media stories.”

BACPR are proud to announce that our qualifi ed instructors can now revalidate online. In a commitment to make education and training more accessible the team are now developing the BACPR Standards and Core Components as an online education resource with a view to further online courses becoming available in the future.

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Physical Activity and Exercise in the Management of Cardiovascular Disease Part 1 : Principles and PracticalitiesThis course provides a 2-day foundation programme in the principles of physical activity and exercise in the prevention and management of cardiovascular disease. This course includes both a theoretical and practical component aiming to equip health professionals with sound knowledge and understanding as well as key practical delivery skills required to meet the core standards and national guidelines for delivery of group, one-to-one and home activity programmes. This course is for any health professional advising on or delivering physical activity and exercise to cardiac patients in either a primary or secondary health care setting.

• 2nd / 3rd November 2013, Manchester

• 15th / 16th November 2013, London

Cost £300 – 350 depending on BACPR/ACPICR membership

Physical Activity and Exercise in the Management of Cardiovascular Disease Part 2: Advanced ApplicationsThis course extends the core knowledge, understanding and skills gained in Part 1 to clinical reasoning for the inclusion of the higher risk and complex cardiac patient, such as heart failure, arrhythmias, ICDs, unstable blood pressure and diabetes. In addition additional subjects explored include the safety of high intensity sports and activities, resistance training, water-based activity and difficult clinical scenarios. This course is for experienced cardiac rehabilitation practitioners who are challenged with the higher risk complex patient. It is strongly advised that participants should have completed Part 1 or the BACPR Exercise Instructors Qualification prior to Part 2, as the subject matter is directly linked.

• 20th / 21st September 2013, London

• 25th / 26th January 2014, Manchester

• 7th / 8th February 2014 , London

Cost £300 – 350 depending on BACPR/ACPICR membership

Health Behaviour Change and Psychological Support in Cardiovascular DiseaseExplore ways of incorporating psychological principles within your service.

• 14th / 15th March 2014, Galway*, Ireland

Cost £320 (£280 to BACPR members)

Physical Activity and Exercise in Heart Failure: Assessment, Prescription and DeliveryFollowing NICE guidance are you including heart failure patients in your programme? Do you want to find out more about how to prescribe safe and effective exercise to patients with heart failure?

• 19th October 2013, Manchester

• 8th November 2013, London

• 29th November 2013, Galway*

Cost £175 ( £155 to BACPR members)

Adapting Exercise: Enhancing skills to accommodate all abilities from seated to high level activity within a group settingFocuses on developing leadership, teaching and delivery skills to facilitate a safe, effective and well-managed programme to a functionally diverse client group

• 19th October 2013, Coventry

Forthcoming BACPR courses

NB: Package price available if booking Part 1 and Part 2 at same time along with a special 10% discount voucHer to be used on a

future course.

Please contact education@bacpr.com or visit www.bacpr.com for more details and application forms on all the above courses.

If you are interested in hosting one of the courses in your area or would like us to develop a course for your local needs please contact one of the education team

BACPR Education, Suite 8, The Granary, 1 Waverley Lane, Farnham, Surrey GU9 8BB.

Tel: 01252 854510 Fax: 01252 854511

The BACPR has an extensive educational programme which also includes:

• Dietary approaches in the management of CVD

• Functional capacity testing in clinical populations

• Monitoring exercise intensity – HR, RPE and METs

• BACPR Level 4 Exercise Instructor Training Qualification

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Invited contributions published in this newsletter may not represent the official stand point or opinion of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR).

BACPR is not responsible for the contents or reliability of any of the website links included within this newsletter and any listing should not be taken as an endorsement of any kind.

Diary DatesESC Congress 2013

31 August - 04 September 2013, Amsterdam, The Netherlands

BACPR conference 2013 3-4 October 2013 St. John’s Hotel, Solihull, Birmingham

CACR 2013 Annual Meeting & Symposium

October 17-18 2013 Montreal, Quebec Palais des congrès

Nutrition and Health Live 2013

1-2 November 2013 ExCeL Conference Centre, London

M&K Update: Developing Leading-edge Cardiac Services: Evidence from the front line

12 November 2013 Manchester Conference Centre

British Society for Heart Failure 16th Annual Autumn Meeting

28-29 November 2013 Queen Elizabeth II Conference Centre, London

British Society for Heart Failure - Heart Failure Nurse Study Day

21 March 2014 Glasgow

EuroPRevent 2014

8-10 May 2014 Amsterdam - Netherlands

World Heart Federation World Congress of Cardiology 2014

4-7 May 2014 Melbourne, Australia

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the British Association for cardiovascular Prevention and rehabilitationBritish Cardiovascular Society, 9 Fitzroy Square, London, W1T 5HW

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