newsletter summer 2011 - bacpr · oral abstracts / poster presentations / exhibition gala dinner...

NewsletterSummer 2011

Contact: BACPR, c/o BCS 9 Fitzroy Square, London W1T 5HW. Tel: 020 7380 1919 email: [email protected] Web: www.bacpr.com

Annual Conference 6-7th October, 2011Brighton, Thistle Hotel

Partnership working to improve care

IndexP2 Note from the Editor

P2 From the President

P3 BACPR Conference 2011BACPR and BHF Award

P4 BACPR Conference

P5 Our new website

P10 NHS Improvements

P12-14 News from the regions

P15-18 BACPR Education

P18 Diary of events

P5 Standards and Cores Components updateBACPR-EPG Competences update

P6 BHF Update

P7 What’s new on NACR?

P7-8 EuroPRevent 2011

P9 ACS report

SEE YOU IN BRIGHTON!

mailto:[email protected]

























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Message from the EditorsWe're delighted to provide you with this second special edition Newsletter, packed with announcements, news and highlights from the many activities planned and currently underway in your association. Thank you to everyone who has contributed. We very much hope you find the content informative as well as an enjoyable read.

The phone lines have opened for the BHF/BACPR Celebrating Cardiac Rehabilitation Award and the numbers to call are within. Do take part in raising the profile and supporting this important acknowledgement of cardiac rehabilitation at a national level. You can come and celebrate this award at this year's annual conference. The programme for our annual conference in Brighton is finalised and includes expert speakers, sessions in partnership with many of our affiliates and a range of key note as well as concurrent sessions, including topics for all the Core Components of Cardiac Rehabilitation.

We've been most pleased to receive many news items from our members and would welcome contributions to the next edition, planned for this late autumn. Please do get in touch!

Hope to see you in Brighton!

Charlotte-Anne Wells and Jenni Jones

Dear Member, Welcome to our second special edition e-News for the spring and summer of 2011. We're now well into the BHF/BACPR award and have the top 10 programmes being evaluated by the expert panel of judges. All this is part of the growing preparations for our Annual Conference in Brighton in October, which will not only feature our traditional keynote sessions but the choice of multi-professional parallel sessions on nursing and clinical care, dietetics and physical activity. We encourage you to review the programme. Key members of the council continue with their enduring efforts to enhance your experience and benefits as a member with many key projects now underway:

• The BHF /BACPR Celebrating Cardiac Rehabilitation Awards 2011 (Led by Gill Furze)• Conference planning and implementation (Gill Furze, Jenni Jones, Kathryn Carver, Sally

Hinton and Lulu Ho)• Website development (Paul Smith, Lulu Ho and Sally Hinton)• The Standards and Core Components update (Patrick Doherty, Susan Connolly, Linda Speck,

Jenni Jones, Gill Furze, John Buckley)• Education and Competency Framework developments (Wendy Churchouse, Sally Hinton, Annie

Holden (BACPR EPG & team), • E-newsletters, where we welcome on-board Charlotte-Anne

Wells to the lead editorial team We continue to receive "good news stories" from the networks and individual programmes including two stories of 25 year celebrations in Scotland and Wales. We are keen to hear your stories and good news, so please write to us. Wishing you well for a bright and warm summer John BuckleyPresident

From the President




















































BACPR CONFERENCE 2011:

Have you booked yet? Got your best dress (or bowtie) ready for the Gala dinner?

This year's conference is not to be missed!

Key note lectures from International expertsProfessor Barry Franklin on Lifestyle Modification

Dr Stephan Gielen on Highlights from EuroPRevent Geneva 2011

Professor Bob Reid on Behaviour Change

See our enclosed profiles of keynote speakers (page 4)

Expert sessionsDealing with psychological problems

Managing heart failure

ICDs in cardiac rehab

Examples from pilot commissioning sites

Breakout sessionsHighlights from PCCS 2011

Physical activity consensus statement

Appetite, glycaemic index and obesity

Smoking cessation

Triggers for cardiac events

Congenital heart disease

Which type of fat should we be recommending?

PlusBHF and BACPR Celebrating Cardiac Rehabilitation Award

Oral abstracts / Poster presentations / Exhibition

Gala dinner with comedian John Ryan

To view the full programme visit: BACPR Conference 2011

Registration is open; please click here to access it: BACPR Conference Registration

See you in Brighton.

Gill and the conference team


BACPR and BHF Award

The British Heart Foundation (BHF) and the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) wanted to celebrate the achievements of the cardiac rehabilitation programmes across the UK, and to share innovative good practice with other cardiac rehabilitation teams. So the Celebrating Cardiac Rehabilitation Award was born.

We asked all cardiac rehabilitation programmes listed on cardiacrehabilitation.net to tell us about themselves. We wanted to know about their comprehensive range of services, their innovative ways to reach out to their local community, and what audit of their programmes had shown. The BHF provided sponsorship to award a first prize of £2000 and two runner-up prizes of £500, to be used for service improvement. Forty teams from across the UK entered for the award and the panel of expert judges had a very difficult task to pick the best ten in their opinion.

We want your help to find the final three programmes, which will all win a prize. A brochure detailing each of the programmes is available on www.bacpr.com and all BACPR members will receive a pdf copy of the brochure by email as part of sharing good practice. The overall winner will be decided at the BACPR conference in October 2011.

After reading the brochure, please vote for the programme which you think would best suit you if you were a patient needing to attend cardiac rehabilitation! The winner will be decided by the vote and our expert panel

There are 2 ways you can vote:1. Email: Please send an E mail to [email protected] stating the name

of the team in the subject line. No other information is necessary.

Emails are free to send but are restricted to one vote per email address. Closing date is 9am on July 4th 2011. Emails sent after the closing time and date will be discarded.

2. Telephone Vote: The numbers for each programme are shown below. Lines open at 9am on the 6th June 2011 and close at 9am on the 4th July 2011.Votes received after the closing date will not be counted but may still be charged. Each phone vote costs 26 pence per call from a BT landline. Please note that payphones, mobiles and non-BT network provider charges may vary. 9p from each call will be donated to the BHF.

Service supplied by: Advanced Telecom Services, PO Box 788, London EC1V 7ZA.

Customer Services: 0845 121 2891 [email protected]

"Celebrating Cardiac Rehabilitation" Award 2011Partnership working to improve careThursday 6th & Friday 7th October, 2011 Brighton, Thistle Hotel

Name of ProgrammeLancashire Teaching Hospitals NHS Foundation Trust CR ServiceNHS Ayrshire and Arran CR ServiceFife CR Service, NHS FifeImperial College Healthcare NHS Trust CR ServiceEast Kent Community CR Service, Kent Community Health NHS TrustNewham Community CR Service, East London NHS Foundation TrustCwm Taf Health Board CR DepartmentRoyal Wolverhampton Hospitals NHS Trust CR ServiceCounty Durham And Darlington NHS Foundation Trust (Secondary Care) CR ServiceSandwell and West Birmingham Hospitals NHS Trust CR Service

Number to Ring0901 121 03010901 121 03020901 121 03030901 121 03040901 121 03050901 121 03060901 121 03070901 121 03080901 121 0309

0901 121 0310

The numbers for each Cardiac Rehabilitation (CR) programme are shown below:

http://www.bacpr.com/resources/BACPR_2011_Annual_Conference_Programme_.pdf





































http://www.bacpr.com/registration/default.asp?navcatid=173























































































































































BACPR Conference attracts world leaders in cardiovascular disease prevention and rehabilitationDr Barry Franklin, is truly respected as one of the world's leading authorities in exercise and cardiac rehabilitation. He is Director of the Cardiac Rehabilitation Program and Exercise Laboratories, William Beaumont Hospital, Royal Oak, Michigan, and Professor of Physiology, Wayne State University, School of Medicine, Detroit, Michigan. He is the past Editor-in-Chief of the Journal of Cardiopulmonary Rehabilitation and Prevention, and is a past president of the AACVPR (1988) and the ACSM (1999). He holds formal editorial board appointments with 15 different scientific and clinical journals, including the American Journal of Cardiology, Medicine and Science in Sports & Exercise, and the American Journal of Health Promotion. Currently, he sits on the Board of Trustees of the American Heart Association. Dr. Franklin and his associates have studied the physiologic responses to numerous occupational and leisure-time activities. Other areas of research interest include the primary and secondary prevention of heart disease, exercise physiology and obesity. Dr. Franklin has written or edited more than 500 publications, including 387 papers, 79 book chapters, and 27 books.

Dr Stephan Gielen is an Associate Professor of Medicine in the Department of Internal Medicine/Cardiology, University of Leipzig Heart Centre, Germany and President-elect of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). He is most widely known for his world-renowned work with Prof Rainer Hambrecht on improved coronary artery endothelial health and function as a direct benefit of aerobic exercise. So beneficial they have shown an equivalent if not greater benefit of exercise to angioplasty! He has also been a world leading authority on rehabilitation and Heart Failure.

Dr Bob Reid is an Associate Professor in the Faculty of Medicine at the University of Ottawa and Associate Director of the Prevention and Rehabilitation Centre at the University of Ottawa Heart Institute. He has a B.Sc. (Human Kinetics), M.Sc. (Exercise Physiology) and MBA (Marketing) from the University of Ottawa and a Ph.D. (Health Studies) from the University of Waterloo. He is one of Canada's leading health behavior change experts, particularly concerning smoking cessation, physical activity promotion and cardiovascular rehabilitation. His research is funded by the Heart and Stroke Foundation of Ontario, the National Cancer Institute of Canada, the Canadian Tobacco Control Research Initiative, the Ontario Ministry of Health Promotion, the Change Foundation, and Health Canada. He is a past recipient of the Heart and Stroke Foundation of Canada's New Investigator Award. In 2006, he was awarded the James Hogg Award from the Canadian Institutes of Health Research Institute for Circulatory and Respiratory Health for his contributions to clinical and population health research.


REMINDER CALL FOR CONFERENCE ABSTRACTSAbstracts are invited for submission no later than 30 June 2011 for oral or poster presentations. Abstracts giving details of research or innovation in cardiac prevention and rehabilitation will be considered for oral presentation in the breakout sessions. Abstracts should:

• Be submitted via email to [email protected]• Please send as a .doc attachment• Be no more than 250 words in length• Be in word format using 12 point size Arial font• Have a title in capital letters, and the organisation involved• The name(s) of the author)s) must be preceded by initials only• Omit titles and degrees and underline only the main presenter• Add full postal address and email address of the main presenter at the end

Please indicate your preferred form of presentation; oral or poster. There will be prize plaques for best abstract accepted for oral presentation and for best poster. If you have not received an email confirmation of receipt from the BACPR co-ordinator within 10 working days of submission, please re-submit abstract or call 020 7380 1919.











































































Our NEW Website: www.bacpr.comBACPR has recently redesigned its website as part of an ongoing strategy to improve communication and engagement with its Membership. It has been developed specifically to provide a more navigable resource, with further plans in-hand to develop additional features for Members. Visit the new website for information concerning BACPR, its membership, education programmes and conferences, together with other resources and news relevant to cardiac rehabilitation practice: www.bacpr.com


Standards and Core Components updateBACPR's new model for representing the core components of cardiovascular prevention and rehabilitation now forms the centre-piece of the Standards currently being revised at the moment.

Rest assured there are no real significant changes to the current Standard just an increased emphasis on the important role that Education and Health Behaviour Change has to play in ensuring that effective care and outcomes occur in the other five core components of Psycho-social health, Lifestyle Risk Factor Management, Medical Risk Factor Management, Cardio-protective Therapies and Long-term Management. The final 7th component which has now gained an equal position to these other six, is Audit and Evaluation.

Essentially the service specifications laid out by the Department of Health's Commissioning guide that should be at the heart of any service, need to be a minimum standard met by all programmes as assessed by using the NACR.

The aim is for the revised Standards to be finalised and presented at our Annual Conference in October, 2011.

Summary of the Core Components of Cardiac Rehabilitation (Draft)

BACPR-EPG Competences updateAs part of BACPR's goal to provide competency frameworks for all components of Cardiac Rehabilitation, the BACPR-EPG has set the process in motion to develop competences for physical activity and exercise. This has been a desire for many years. Wendy Churchouse, who recently joined council, is then tasked to lead the development of core competencies for the other core components, with the overall ambition being to provide the highest quality care to our patients.

A working group has been formed to develop this first framework which will provide one single document outlining competences required for the physical activity and exercise component of the patient's journey through cardiac rehabilitation. This document will define competences for the exercise professional and supporting staff involved. The ACPICR had an objective in 2010 to review their competences document, so it was an opportune moment to continue to work collaboratively across our three representative organisations (ACPICR, Exercise Instructor Network (EIN) and BASES Exercise Practitioners Group) to produce one comprehensive document.

Funding from BACPR has supported this important area of development work. The working group has so far achieved the following:

• an initial scoping exercise to identify the range of competences currently available within reference documents across the professions

• identification of all existing performance criteria within headline competences from these reference documents and any missing performance criteria

• commencement of a mapping exercise to consolidate the range of competences and confirm the performance criteria within each competence.

This involves a lot of challenging work! The working group's aim is to have a first draft ready for consultation towards the end of this year. The overall aim is for BACPR to simultaneously map and subsequently develop competency frameworks for all the Core Components of Cardiac Rehabilitation.




















































"The BHF is launching a new DVD resource, 'Active Heart, Healthy Heart' in mid-June. The DVD delivers home-based exercise programmes and has been designed by cardiac rehabilitation teams, BACPR phase IV qualified exercise professionals and is suitable for most levels of fitness. It is intended to be given to patients with appropriate assessment and on-going support provided by suitably qualified professionals. The DVD provides different types of exercise programmes including a seated exercise programme, designed for patients with a lower capacity for physical activity. For more information please email Matt Parsons on [email protected]."

British Heart Foundation Update


The British Heart Foundation has a new service to support health and wellbeing in the workplace called 'Health at Work'.

Designed for a coordinator/ champion, it gives useful advice and tools on how to set up a health and wellbeing programme in your workplace. It explains how investing in such an initiative offers benefits for both the organisation and employees and highlights some of the common pitfalls and how to overcome them. It also has great ideas for developing your programme including ways of promoting physical activity, healthy eating and mental wellbeing.

Best of all it's free to join! On joining you will receive a welcome pack that includes a 'quick guide to health at work' to get you started and provides ideas for your wellbeing programme. To keep you up-to-date we have a Health at Work e-newsletter that will be sent straight to your inbox once a month full of new ideas, events, campaigns, case studies and signposts. Join today at: www.bhf.org.uk/healthatwork

Wait there's more, visit the website (www.bhf.org.uk/healthatwork) and you'll find popular downloads such as our pedometer challenge and posters to advertise your events; we have resources on physical activity, healthy eating and mental wellbeing you can order; information on heart matters - BHF's free service for individuals who want to live with a healthy heart; case studies and much more. For more information please contact [email protected]

The healthy hearts kit now have a second set of food cards - (G453g) to compliment the original set of food cards. You are able to order the eat well plate mat (G 453e) and set 1 food cards ( G453c) separately.

We are able to offer a pass it on training to support the delivery of the Healthy hearts kit and are always looking out for case studies of successful ways that the kit has been used. For more information on this please contact [email protected]



















































http://www.bhf.org.uk/healthatwork)

http://www.bhf.org.uk/healthatwork)


The BACPR have recently highlighted the threat to CR services due to the £20 billion shortfall in NHS funding expected over the next two years, or, in Department of Health speak "efficiency savings". The NACR combined with the BHF Campaign for CR is probably our best defence if we are not to loose the ground we have been making. Showing what is happening within and between services locally, regionally and nationally is going to be fundamental to the further development and possibly to the survival of CR programmes.

We are delighted to announce that Prof. Patrick Doherty is now working with the NACR team in a joint project with NHS Improvement and the BACPR to align the NACR with the DH CR Commissioning Pack. This will provide reports that meet the needs of both providers and commissioners. In the longer term, our intention is to join the surgeons and other cardiac audits by offering quantifiable and meaningful outcomes for clinicians, providers, commissioners, patients and for local and national benchmarking and quality control. There will be no immediate change to the database for most users (including the use of stages). The programmes taking part in the NHS Improvement CR National Priority Project are piloting a slightly different version of the database. This will be evaluated later this year and its outcomes will be shared at relevant conferences and via NACR, NHS Improvement and BACPR newsletters. Any changes that are eventually required for all users will be very small but very meaningful in terms of output and the NACR team will ensure that CR programmes are fully supported to manage any such changes.

For all users we have introduced further requested improvements to the database. The discharge report has been improved, and is currently in its 'feedback' period - if you have any comments on it, please let the team know as we'll be reassessing it in September; the Quarterly Reports are now available to all users directly from the database programme; and we are working on a new Phases report. We have also had to make collecting the NHS Number mandatory. We know that for some users this is difficult but we have no choice in the matter - this is an Ethics and Confidentiality Committee (ECC) requirement, for all medical audits from mid-June this year. If you are having problems with this or any other matter to do with the NACR, please do contact the team; we love to hear from you, whether the news is good or bad!

Contact details: Corinna Petre, NACR Project Manager email: [email protected]

Nerina Onion, Training and Information Officer, email: [email protected]: (01904) 321326

What's new on NACR?


EuroPRevent is the biggest cardiovascular prevention and rehabilitation meeting in Europe and this year attracted over 1,350 delegates to the beautiful city of Geneva between the 14th and 16th April 2011. Participants included epidemiologists, clinical cardiologists, nurses, sports physiologists, basic scientists, dietitians and physiotherapists. Seventy of the delegates were from the UK most of whom were giving presentations

We enjoyed an extensive programme of extremely high scientific level covering all fields of cardiovascular prevention and rehabilitation, including epidemiology, public health, clinical cardiology, basic science, exercise, sport physiology and nutrition.

Some of the Highlights: A special session was given by Professor Salim Yusuf who spoke about his personal views on CVD prevention. His career spans both cardiology and epidemiology and he has been the principal investigator in many of the landmark studies which established today's current practice in cardiology, including SOLVD, HOPE, OASIS, CURE and INTERHEART. Professor Yusuf gave a fascinating account of his work over the past 20 years aiming to reduce mortality and morbidity with simple inexpensive treatments.

EuroPRevent 2011 Geneva





















































Other presentations of notable interest included: EuroCaReD (the European Cardiac Rehabilitation Database). A late breaking clinical trial which was launched in October 2010 as a pilot project to assess the guideline relation and effectiveness of cardiac rehabilitation programmes across Europe. EuroCaReD is an internet based survey, which has the potential to link existing cardiac rehabilitation databases in the European countries, and also those institutions which plan to join in the future.

Predicting and communicating CVD risk to patients and populationsIn a fascinating session on newer methods of predicting risk for CVD, three different risk prediction tools were showcased. After David Wood set the scene, Rod Jackson introduced us to the New Zealand "Know your numbers" heart age tool which assesses lifetime risk (http://www.knowyournumbers.co.nz/heart-age-forecast.aspx) and explained the difference between this and tools which look at short term risk (as in JBS2 or the European Score tool). Guy De Backer countered with an explanation of Score (which assesses 5 year risk). Mark Cobain then described the Flora Heart Age tool (which assesses 15 year risk) which is targeted at members of the general public. Their research showed that the tool alone does not help people to change their risk behaviour - for that you need health professionals to intervene to support health behaviour change. The main point from the session is that we need to help people who do have higher risk for developing CVD to change their behaviour and reduce their risk - however it is measured.

Don't delay in starting patient exerciseA meta-analysis on 12 randomised control trials by the group at Palo Alto California led by Dr Jonathan Myers, reported that the earlier patients start on exercise post-MI the better. The studies totalled 647 patients (average age 55 years) with a mean ejection fraction of 44% at baseline. There was no evidence of harm from starting exercise rehabilitation within 1-week post-MI. Left ventricular remodeling improved most for exercise starting within one-week after myocardial infarction and continuing for more than three months. With each week delay in commencing rehabilitation it was estimated that patients would need an extra month training to gain the same beneficial remodelling benefit.

Novel ways to change physical activity behaviourThis session highlighted the importance of the "built environment" on preventing inactivity. An entertaining video clip was presented on getting people to take the stairs rather than the escalator. The original work on this concept was published by Blamey et al. in 1995 (BMJ 311: 289 - 290).

Now go to www.Youtube.com and type in "Musical Stairs!"

Monitoring changes to microvascular health with retinal scanning This session presented by Drs Arno Schmidt-Truksass and Henner Hannson from the University of Basel, provided their evidence of measuring changes in the retinal microvascular-arterial responses to exertion. This is a simple non-invasive technique that looks more closely at the retinal arteries during a typical scan and using a flicker light to stimulate vasodilation. Two key results were highlighted:

1. microvascular arterial dilation capability was closely associated with key CVD risk factors (blood pressure, lipids, and physical activity);

2. the ability of the microvasculature to dilate improved with an exercise training programme.

This research continues to follow on from previous studies showing the important link between vascular responsiveness to dilate and the unhealthy progression of atherogenesis.

Dr Stephan Gielen joins us at BACPR conference 2011 in Brighton for a session on the Highlights from EuroPRevent 2011.The BACPR is aiming to have more involvement in next years EuroPRevent as it is being held in our neighbouring country of Ireland. Hope you can make it.


http://www.knowyournumbers.co.nz/heart-age-forecast.aspx

http://www.Youtube.com



















































In March 2011, the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) joined forces with other professional groups, patient groups and key clinicians to create a future-focussed report on how care can be improved. The Big Question: The Future of Acute Coronary Syndromes Patient Outcomes Report was produced by AstraZeneca, HEART UK, BACPR and ACE with an aim to increase clinical understanding of what needs to be done to improve patient care.

The report was launched at a parliamentary reception at the House of Commons, where patients, healthcare professionals, professional groups and MPs gathered to call for renewed focus to prevent thousands of avoidable deaths in the UK as a result of heart attacks and unstable angina. Support was also provided by Professor Roger Boyle CBE, National Director for Heart Disease and Stroke and Sir Ranulph Fiennes, International Explorer and heart attack survivor.

British Association for Cardiovascular Prevention and Rehabilitation join the call to improve the care of patients with Acute Coronary Syndromes


BACPR TRAVEL AWARDWe are pleased to welcome applications for the BACPR Travel Award. Funding of up to £2,000 is available. Applications are welcome up until 31st August 2011. For regulations and application information please visit: BACPR Travel Award.

For queries please contact: www.bacpr.com or Tel: 020 7380 1919

At a time when all areas of the NHS are vying for additional support to protect their frontline services, it is acknowledged that additional funds are not available and so improvements will need to be funded from efficiency and productivity savings identified from current services offered. Therefore, the recommendations and evidence within the report identify how existing NHS services designed to rehabilitate patients after a heart attack could be better utilised to reduce the current burden of cardiac events both on the healthcare and welfare systems.

Key report conclusions: Broaden access to cardiac rehabilitation: For heart attack patients, access to cardiac rehabilitation has been shown to reduce the risk of subsequent cardiac events. Although some cardiac rehabilitation programmes in the UK have a much higher uptake, the average uptake for the three nations (England, Wales and NI) is 41%1 vs. the government's target of 85% set in 20002, which is far from acceptable

Improve discharge information: As length of stay in hospital following a heart attack has fallen, aftercare is even more important. The NHS Alliance's fourth national survey on hospital discharge data found that 70% of GPs surveyed admitted that patient safety had been put at risk due to poor discharge information from the treating hospital3. Furthermore, 81% of practices reported that details of prescribed medicines were incomplete or inaccurate on discharge summaries "all of the time" or "most of the time"3. The report concluded that discharging hospitals should comply with the new standard contract for NHS-funded hospital care, which includes requirements for discharge summaries to be shared with patients and issues to the patient's GP within 72 hours of discharge

Sir Ranulph FiennesProfessor Roger Boyle



















































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Maximise adherence to medication: Adherence to medication is generally poor in cardiac patients. One study suggests between 8 - 20% of patients stop treatment within 6 months4. The report concluded that GPs should actively encourage treatment adherence, in line with national guidelines. In addition, local health authorities should review the timely adoption of newer medicines and interventions to ensure that patients are receiving the best standard of care possible

Addressing psychological health: Anxiety and depressive symptoms are very common in patients who have suffered a cardiac event. Depression in particular increases the patient's risk of another cardiac event if not identified and addressed5,6. Psychological ill-health makes it more difficult for the patient to make healthy lifestyle changes and is also associated with reduced adherence to medications


From left to right: Eve Knight, Chief Executive, AntiCoagulation Europe; Jules Payne, Chief Executive, HEART UK; and Dr Susan Connolly Consultant Cardiologist and contributing

advisor and author on behalf of BACPR.

Report authors / contributors include: • Eve Knight, Chief Executive, AntiCoagulation Europe • Dr Susan Connolly, Consultant Cardiologist and BACPR council • Judith Edwards, Senior Cardiology Nurse Specialist, Imperial Healthcare NHS Trust • Dr Marcus Flather, Consultant Cardiologist, Royal Brompton & Harefield NHS Foundation

A full copy of the report is available by emailing [email protected].

References: 1. British Heart Foundation. The National Audit for Cardiac Rehabilitation - Annual Statistical Report 2010. BHF 2010 2. Department of Health. Coronary Heart Disease: National Service Framework for Coronary Heart Disease - Modern Standards and Service Models. DH

March 2000 3. NHS Alliance. Fourth national survey into NHS patient discharge information. NHS Alliance June 2010 4. Eagle KA, Kline-Rogers E, Goodman SG, et al. Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing

prospective, observational study. Am J Med. 2004;177:73-81 5. Carney RM, Freedland KE, Steinmyer B, Blumenthal JA, Berkman LF, Watkins LL, Czajkowski SM, Burg MM, Jaffe AS. Depression and five year survival

following acute myocardial infarction: a prospective study. J Affect Disord. 2008 Jul;109(1-2):133-8.Epub 2008 Jan11 6. Haas DC. Depression and disability in coronary patients: time to focus on quality of life as an end point. Heart 2006;92:8-10




















































Cardiac Rehabilitation Commissioning PackNHS Improvement is continuing to support a number of projects across England to improve the commissioning and provision of cardiac rehabilitation through implementation of the DH Commissioning Pack. Although the projects are at various different stages of development, many have already utilised the templates and tools within the Pack to redesign local pathways, produce new service specifications and develop a robust business case for CR. Visit the NHS Improvement website at www.improvement.nhs.uk/heart/cardiacrehabilitation for news, updates and further information.

Work with NACRA joint venture between NHS Improvement (led by NHS Improvement National Improvement Leads) & the NACR team (lead by Bob Lewin) is seeking to test the feasibility of using the NACR database to report the four key outcome requirements featured in the CR Commissioning Pack) in addition to the current clinical audit data.

Initially, the pilot project will involve working alongside a small number of pilot sites to test some new data fields with the intention of being able to generate a commissioner focused report from the existing audit database. The long term aim is for the NACR to become a 'one-stop' database for CR programmes where all their reporting requirements (both clinical and performance) can be captured. Work is still at an early stage and progress will be reported through the website at www.improvement.nhs.uk/heart/cardiacrehabilitation

Further newsWe have been busy travelling round the country helping sites to interpret the CR Commissioning Pack to support the development and improvement of CR locally. In addition we have attended a number of local conferences and presented some of the work we have been doing to a wide range of audiences. Many of the presentations and links to some of the work going on around the country are available to view/ download from our website.

Some members of the team recently attended the All Wales National CR Conference in the delightful Llandrindod Wells - download their presentation here.

Social Marketing EventAlmost 100 delegates from across the country attended this one-day event held on 23 March in London designed to equip CR staff with some of the knowledge and skills required to successfully market cardiac rehabilitation services to patients and professionals.

Visit the website to view/ download the slides and accompanying workbook from the day presented by Professor Jeff French and Clive Blair-Stevens.

We are planning to follow up all those who attended to find out how they have- or intend- to apply the learning to the 'day job'. If the event spurred you into action and you'd like to share your findings, please email [email protected]

Sarah Armstrong-Klein

NHS Improvement: News update


http://www.improvement.nhs.uk/heart/cardiacrehabilitation

http://www.bacpr.com/resources/All_Wales_CR_Annual_Conference_6th_May_2011.pdf


























































The Bridgend & Neath/Port Talbot Cardiac Rehabilitation Service in Abertawe Bro Morgannwg University (ABMU) Health Board, South Wales celebrated its 25th anniversary in January 2011.

The occasion was celebrated by the Cardiac Rehabilitation Team at the Princess of Wales Hospital, Bridgend. Past members of the team, together with patients and also representatives from other cardiac rehabilitation programmes in Wales, cardiologists and members of the Welsh Cardiac Networks were also present. The event began with a number of presentations from both internal and external speakers. Dr John Buckley, President of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) presented an overview of cardiac rehabilitation and its development in the UK. He commended the ABMU service as pioneering, having led the way in the early years when very few areas had such programmes and for continuing to be at the forefront of national developments, such as currently contributing to writing the BACPR Standards for cardiac rehabilitation services in the UK.

David Boland, a former patient of the service shared his experience of the programme: "One of the best features of the rehabilitation programme is that during your seven weeks it clears up many myths. For example, there are different ideas that people have about the risks surrounding driving, drinking alcohol and safe amounts of exercise after you have had a cardiac episode or surgery".

"Talking about your week to a sympathetic group and knowledgeable professionals is an important psychological aid towards recovery. Rehabilitation encourages you to say what you are feeling both physically and emotionally.

"I'd like to thank the team of rehabilitation professionals on behalf of everyone who has benefitted from the programme. It has given us all a fresh lease of life."

Dr. Linda Speck, Consultant Clinical Health Psychologist, Cardiac Rehabilitation Manager described the development of the ABMU Service and of the struggle to establish it with very little funding but plenty of commitment and goodwill, during its early years. She said, "I'm delighted with the success of our Cardiac Rehabilitation Service. It's come a long way since it began 25 years ago. We not only help patients with their physical recovery and work with them to address their risk factors for coronary heart disease, but also offer support for the emotional and confidence issues they may face following a cardiac event. The achievements of the service are due to the hard work and dedication of each individual member of the multi-disciplinary team. We're all looking ahead to the future and further expansion to include more cardiac patients."

The cardiac rehabilitation team is currently staffed by physiotherapists, Kay Evans, Andrew Harvey and assisted by Yvette Colwell. The cardiac rehabilitation nurse specialists are Ann Harvey, Lydia Mason, Julia Thomas and Leanne O'Dwyer; cardiac rehabilitation health visitors, Adrienne Cook and Judith Perry, plus Patricia Bumford, Dietitian. Pharmacists, Kate Webb and Jennifer Richards also provide some input to the service. Dr Linda Speck and Michele Gray are clinical and health psychologists who are fully integrated members of the team. The service has invaluable secretarial support from Jan Morris, Kerry Tucker and Alisa Bourne.

ABMU Health Board Chairman, Win Griffiths, commented: "This service has played a tremendous part for people with heart related problems. It has helped people who have suffered a huge life shock come to terms with it and recover. It gives them the confidence to lead a more normal life."

The Cardiac Rehabilitation Service began in January 1986 as a research programme, providing information and psychological support. It was the first cardiac rehabilitation programme to start in Wales, with only a handful in existence in the rest of Britain at that time.

By the early nineties, it had become an established service for patients recovering from heart attacks and cardiac surgery in Bridgend and the Western Vale of Glamorgan, working with them at all stages of their recovery. It received the Good Health Wales 1996 Award for an innovative programme, "Heart Education for Life, Maesteg (HELM)", which not only delivered cardiac rehabilitation but also worked with relatives of those suffering a cardiac event, to address their risk factors for coronary heart disease and their lifestyles.

Additional funding was received from the Welsh Assembly Government in 2002 to expand the service. By this time, Bridgend had merged with Neath/Port Talbot and this new funding was instrumental in establishing programmes in that area.

News from the Regions


First Cardiac Rehabilitation Service in Wales reaches a quarter of a century



















































Now, a multidisciplinary team of cardiac rehabilitation specialist nurses, physiotherapists, dietitians, psychologists, pharmacists, health visitors and secretaries is available in Bridgend and Neath Port Talbot. The team sees over 750 patients a year, providing the support they need to regain their confidence with individually tailored advice to promote a healthier lifestyle, thereby reducing the risk of further cardiac events. Also, partners, including other close family members, are invited to attend. Patients' recoveries may be influenced by their partners and families, they often needing support and information themselves and they may benefit from the information imparted to address their own personal risk factors for heart disease.

'Jordanhill Hearties' Phase IV Cardiac Rehabilitation Group celebrates its 25th Anniversary.


Bridgend & Neath/Port Talbot Cardiac Rehabilitation

In 1985 Glasgow and the West of Scotland had some of the highest rates of CHD in the world, there was no organised rehabilitation for people who had experienced a cardiac event. Two physiotherapists, Mary Newton (PhD) and Morag Thow (PhD, MBE), approached Dr John McArthur (Consultant Cardiologist) of the Western Infirmary and a pilot 'Phase III 12 week exercise programme' began at Gartnavel General Hospital. This pilot proved very successful and the 12 patients then requested a community maintenance exercise group. The 'first ever' phase IV community based programme in Scotland was established - The Jordanhill Hearties! Our programme became the model that all Glasgow hospitals caring for cardiac patients adopted for patients and families across the city.

The Jordanhill Hearties continue to go from strength to strength, adapting to new accommodation and challenges. They are one of the biggest Phase IV cardiac rehab groups in Glasgow, helping to keep on average 60 people active every week. The Jordanhill Hearties have a satellite group at Killermont Parish Church Halls in Bearsden providing two further exercise sessions every week. The committee and members organise social activities and fund raising events always with an active theme.

Over the years many physiotherapists and student physios have gained valuable experience in class leadership and inspiration from the wonderful people involved in the group. Due to the ongoing support from Dr. Morag Thow (Senior Lecturer, Glasgow Caledonian University) the Jordanhill Hearties have been involved in numerous research projects building an ongoing body of evidence for this specific client group.

Now, Glasgow has one of the largest and most comprehensive cardiac rehabilitation programmes in the UK and the Jordanhill Phase IV cardiac rehab group are most definitely at the heart of it!

Some of the members share their experiences………..

Hettie Lindsay's husband 'Willie' was the twelfth person to join the new phase IV exercise class at Jordanhill. She says "I have been attending the classes for 25 years. At 93 years of age I still enjoy the exercise but most of all I love the comradeship and happiness I have always experienced."



















































Sylvia Johnston says, "My husband was the first person on the list when the class started 25 years ago. I am still having my weekly dose of exercise, fun, friendship, advice and support".

Iain Laidlaw (Treasurer), "I had a MI in 1991 and a bypass in 1992. I have been regularly exercising ever since. At the start of phase IV I felt safe with the physios in the group environment. I really enjoy the classes and appreciate the support and comradeship. So in addition to the physical benefits I know the psychological benefits are immense. I would go so far as to say that the rehab class saves lives and I thank the day that Morag and her team started".

George McLean (Chairperson), "I had my heart event in 1990. The classes have been extremely beneficial in both fitness and in the many kindred spirits. I can't imagine not attending"

Author: Keri Graham MSc (Lead Physio, Jordanhill Hearties)


Home Based Cardiac Rehabilitation in Northern IrelandThe Heart Manual was first introduced to Northern Ireland in 2004 when a strategic review of cardiac rehab in the rural Western Trust area indicated that individuals were missing out on rehab for reasons such as difficulty with transport, distance to travel and disruption to family arrangements. With the support of Chest, Heart & Stroke and local GP's funding was raised for a pilot project of the Heart Manual in the Trust area and now 60 patients extra each year are receiving cardiac rehabilitation in addition to those attending formal cardiac rehab classes.

The evidence from the latest Cochrane systematic review 2010 has shown that Home and centre-based cardiac rehabilitation appear to be equally effective in improving the clinical and health related quality of life outcomes in acute MI and revascularisation patients?. This finding, according to Taylor et al (2010) would support the extension of home-based cardiac rehabilitation programmes such as the Heart Manual to give patients the choice in line with their preferences, which may have an impact on cardiac rehabilitation in the individual patient?

Now the Northern Trust has been successful in securing funding from The Queen's Nursing Institute and Burdett Trust for Nursing, London to launch the Home Based Cardiac Rehabilitation Project.

Patients who do not take part in cardiac rehabilitation following a heart problem are 25% more likely to die in the following two to five years. This project aims to deliver a programme of cardiac rehabilitation to patients with heart disease living in rural areas, who are unable to attend hospital-based programmes. The service will provide patients with the opportunity to become experts in their own health, taking back control of their lives and ultimately living longer with a better quality of life.

Alana Laverty, Cardiac Rehabilitation Development Co-ordinator said, "Funding will be used to run a pilot in the Magherafelt and Cookstown areas using the Heart Manual. This is an evidence-based, self-management, home cardiac rehabilitation programme lasting between 6 -12 weeks which will be facilitated by a cardiac rehab nurse.

"The Magherafelt and Cookstown areas will be targeted first due to a poorer uptake of the hospital-based programme for mainly geographical reasons and Cookstown has the third highest death rate from heart disease in N Ireland.

"The objectives of the project is to improve clinical outcomes by ensuring targets are met in relation to blood pressure, cholesterol levels, helping smokers to quit, attaining 30 minutes of exercise per day on at least 5 days/ week, losing weight if necessary and ensuring that they are prescribed and taking the four main recommended drugs. The project will improve quality of life, decrease anxiety and depression levels and reduce unnecessary hospital admissions, visits to GP's and cut death rates.

Alana Laverty Cardiac Rehabilitation Development Coordinator, Northern Health & Social Care Trust

Patricia McGartland Cardiac Rehabilitation Specialist Nurse, Western Health & Social Care Trust

Taylor RS , Dalal H, Jolly K, Moxham T, Zawada A. Home-based versus centre-based cardiac rehabilitation. Cochrane Database System Review. 2010 Jan 20;(1): CD007130



















































BACPR Education


Course review• I attended this Study Day with another colleague from the Cardiac Rehabilitation Department at the University Hospital

of North Staffordshire. As expected, the day was both extremely interesting and informative. The variety and detail of the presentations helped us to identify the areas of our service where improvement was needed, but at the same time allowed us to reflect upon our successes. The day also provided us with a fantastic opportunity to meet other Cardiac Rehabilitation teams from around the country and to discover how their services were addressing the same challenges that we faced. We left the course feeling very positive about the importance of Cardiac Rehabilitation as a cost-effective and proven intervention.

Paul Stern BSc (Hons) MSc MCSP, Consultant Exercise Physiologist (University Hospital of North Staffordshire)

Forthcoming dates

11th November 2011, Manchester

Physical Activity and Exercise in the Management of Cardiovascular Disease Part 1: Principles and Practicalities

Course review• This course provided both excellent revision and introduced new ideas in the activity and exercise as part of the

management of cardiovascular disease. There was a good mix of topics, workshops and practical sessions which were well presented, informative and fun. The course material, particularly the manual, makes an excellent reference tool and the tables are useful in every day practice. It has already changed the way I work. I have been on many courses over the 30 years since I qualified but it has been a long time since I have attended a course which is so inspirational.

Karen Rowat, Band 7 Physiotherapist, Cardiac Rehab, St Richard's Hospital, Western Sussex Hospitals NHS Trust

Forthcoming dates 17th/ 18th June 2011, Central London25th/ 26th June 2011, Exeter12th/13th November 2011, Manchester 18th/19th November 2011, Norwich23rd / 24th March 2012, Newcastle

How to Ensure your Cardiac Rehabilitation Programme Meets Standards

Physical Activity and Exercise in the Management of Cardiovascular Disease Part 2: Advanced Applications

• This is an excellent follow on course from the Part 1 course and BACPR Exercise Instructor training. This course extends the core knowledge, understanding and skills in Part 1 to clinical reasoning for the inclusion of the higher risk and complex cardiac patient.

Forthcoming dates 25th/26th June 2011, Manchester9th/10th September 2011, London16th/17th September 2011, Exeter24th / 25th February 2012, Norwich29th/30th June 2012, Newcastle




















































Assessing Functional Capacity in Clinical Populations Course Review

• This course was excellent and had very positive feedback from all twenty attendees. The course helped us focus on pre and post assessment for our rehabilitation programmes. The aim was to ensure all staff carrying out functional and capacity assessment felt safe and had the appropriate knowledge. The course helped some of us finally grasp METS! It was a very interesting productive day whilst at the same time being fun. As we are developing our services the knowledge gained from this course is also helping us with patient satisfaction survey and audit. It was a good round off to the Part 1 and 2 Physical Activity and Exercise BACPR courses

Janine O'Rourke, Coronary Heart Disease Specialist Nurse Lead, North Tees and Hartlepool Foundation Trust

Forthcoming dates 4th November 2011, Nottingham19th November 2011, Manchester

Monitoring Exercise Intensity - HR, RPE and METs Course Review

• This one day study day took place in the Grove Well-Being Centre in Belfast on Friday 6th May. It was delivered by Dr John Buckley, using mainly practical workshops which clearly demonstrated how we can monitor exercise intensity more effectively using a variety of methods. The course was attended by 20 delegates from several different disciplines, including cardiac rehabilitation nurses, physiotherapists, occupational therapist and phase 4 instructors. It provided an opportunity to not only update skills and knowledge in monitoring exercise intensity but also to network with others involved in the delivery of cardiac rehabilitation.

• Comments received throughout the day were very positive e.g." I really enjoyed the day and have learnt a lot. The practical workshops were varied and interesting and definitely got the message across" (Phase 4 instructor). I have taken away some very useful pointers in how to use RPE more effectively in phase 3 which I have already put into practice. Some of the key messages obtained from other delegates were:

• "This study day has made me more conscious about the explanation I give to patients in relation to RPE and how to ensure better patient understanding and interpretation of levels of intensity " (Physiotherapist)

• "I will now use the Karvonen method of calculating a prescription heart rate for my patients in cardiac rehabilitation in order to ensure a more individualised and accurate approach" (Cardiac Rehabilitation Nurse)

• I definitely would recommend this course to all cardiac rehabilitation practitioners.• Thanks again to John for delivering a very informative and enjoyable study day.

Maria Mooney, Cardiac Rehabilitation Nurse, Belfast City Hospital, Belfast Health & Social Care Trust

Physical Activity and Exercise Advice in Heart FailureThis one day course aims to increase awareness of the impact of physical activity and exercise in the heart failure patient group.

Forthcoming dates 28th October 2011, Manchester18th November 2011, Chichester




















































Psychological Management and Health Behaviour Change in Cardiovascular DiseaseCourse Review

• This stimulating course was structured to highlight how you would go back and develop your cardiac rehabilitation service. To give a flavour of course the main points to develop our well established service were:

• A reminder to the team that education and behavioural change are central in commissioner's minds. The MacNew Questionnaire (Oldridge) is useful in presenting evidence of outcomes to commissioners.

• How can we reinforce the cardiac rehabilitation message to the medical staff and family members because the initial attitudes a patient gets about heart disease has such a high impact on long term outcomes?

• None of us like being anxious so we will keep asking questions until we hear one thing we want to hear and that may be the wrong message (for example "you are cured"). We need to try and ensure the patient picks up the helpful messages and check what they have actually picked up by the time they get to our service.

• The HADS is invalid if somebody has not answered every question. The HADS is not just a score and should be talked about as part of a process of asking about how people are feeling.

• That we need to review our training for staff rotating through the cardiac rehabilitation service to be clear about how we set goals and use motivational interviewing. Highlight that the aim of the initial interview is to get them to want to come back, for most patients.

• To try to get people to understand Cognitive Behavioural Therapy and to think about how they feel about a roller coaster ride.

• To help reinforce goals it will be useful to get the group to say how important they believe the subject of the education session is to them.

• In the education session we could ask the group to tell us pros and cons of changing the behaviour to be discussed in the session. It confirms what the group already knows and then we can add the information they do not know.

• We peer review the initial interviews our static staff complete but we could change the review to look at how many statements about change the patient makes.

• Reinforce the importance that somebody brings up the subject of sex. A new technique for the team would be "inoculation". This is where in an introduction you might describe a range of subjects that you will be talking through.

If these changes spark your interest then this is the course for you.

Stephanie Slater, Clinical Lead Occupational Therapist, Manchester Royal Infirmary, Cardiac Rehabilitation Program.

Reducing the Risk of Cardiovascular Disease and Managing Weight: A Dietary and Behavioural ApproachThis one day course aims to explore the assessment and prescription of dietary and weight management advice for the cardiovascular group

The course was very useful and I felt that I had a thorough update of dietary aspects of cardiac rehabilitation. Guidance on taking dietary history was very useful. I enjoyed the information about recent research evidence and guidance on how to measure patients' waists!

Maureen Barry, Cardiac Rehabilitation Specialist Nurse

Forthcoming dates 25th November 2011, Manchester 24th February 2012, Central London




















































Adapting Group Exercise for People with Complex Needs in Cardiac Rehabilitation• This NEW course will focus on developing essential practical skills required to manage a group who range from low

function, multi pathology through to high function, low risk.

Forthcoming dates 9th September 2011, London

BACPR Exercise Instructor Training Qualification • Highly respected Level 4 qualification recognised by the Register of Exercise Professionals and SkillsActive.

Courses booked for Dublin, London, Walsall, Glasgow, Newcastle and Loughborough- see website for dates

Please contact [email protected] or visit www.bacreducation.co.uk for more details and application forms for all the above courses

If you are interested in any of the above courses and would like to host one in your area in return for a small fee and a free place please email [email protected] for hosting details .

This manual presents the theory and principles of physical activity and exercise in the management of cardiovascular disease and is now available to buy for £17.99 (incl P+P).

The content of the manual covers the physiological adaptations of exercise training and makes applications of these mechanisms to the design, monitoring and implementation of exercise prescription. This manual accompanies our 2 day Physical Activity and Exercise in the Management of Cardiovascular Disease Part 1 course.

To download the order form: www.bacpr.com/resources

For course information: www.bacreducation.co.uk/courses/physical-activity-and-exercise-courses/

A Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease Course Manual (2009)

BCS Annual ConferenceJune 13-15th 2011, Manchester

ESC CongressAugust 27th-31st 2011, Paris

PCCS Annual ConferenceSeptember 28th - 30th 2011, Bristol

BACPR Annual Conference October 6th and 7th 2011, Brighton

Diary of Events 2011BSH Annual Autumn Meeting November 24th and 25th 2011, London

EuroPRevent 2012May 3rd - 5th 2012, Dublin

World Congress of CardiologyApril 18th - 21st 2012, Dubai

BACPR Annual Conference 2012Autumn 2012, Edinburgh

Invited contributions published in this newsletter may not represent the official stand point or opinion of the BACPR.


































































































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newsletter summer 2011 - bacpr · oral abstracts / poster presentations / exhibition gala dinner...

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