Developing a cardiac rehabilitation program outline in Victoria – methods and preliminary results Dr Susie Cartledge, on behalf of: Deakin IPAN: Emma Thomas, Professor Ralph Maddison National Heart Foundation of Australia: Kerry Hollier, Roni Beauchamp, Dr Sue Forrest Pleasure to present this work I am representing a large group of people who are currently working hard on this project From Deakin University- Emma Thomas, Ralph Maddison From National Heart Foundation of Australia - Kerry Hollier, Roni Beauchamp and Sue Forrest In addition to some expert advisors who I will describe later - Highlight work in progress – take you through the steps of this project

Cardiac rehabilitation in Australia Lacking information to guide CR clinicians on components of what to deliver Lack of program standardisation No CR guidelines in Aus High level recommendations but nothing clinician can pick up and run with No program standardisation Regardless of mode of delivery; telephone, mobile health Really see this as a small piece of work in a larger puzzle- which I will touch on towards the end of the presentation Project funded by the Victorian Government through Safer Care Victoria (SCV) ACRA involvement

Aims Develop a program outline and resource for Phase II cardiac rehabilitation that is: Victorian focus currently, but hope expand to national focus in the future Evidence based – we know that the cardiology community wants to see an EB program so they can feel confident about what they are referring their patients to Vic focus- feel climate is particularly good for a national approach- g Evidence based Standardised Builds on ACRA Core Components Client centred Focuses on the content to be delivered rather than method of delivery iven that there are national working groups both on this project and others- discuss more at the end

- Patient satisfaction literature - Consumer reps - Site visits - Guidelines - Cochrane - Other Systematic Reviews - RCTs - Expert advisory group - ACRA Vic Forum Best research evidence Clinical expertise Consumer values and preferences - Patient satisfaction literature - Consumer reps - Site visits Local context Bringing together all the different forms of the evidence Deakin input academic advisors for BRE section assisting with input to other sections

Methods – module development Content area determined by literature review Evidence mapped to form modules Additional literature review for each module if gaps identified Content expert reviews module Module review by expert advisory group All modules reviewed by ACRA Vic members Module finalised by working group

Results – module overview Cardiac Rehabilitation Foundations - Initial assessment - Education and self-management Psychosocial Psychological well-being Social support & intimacy Developing skills to take care of heart health Exercise Nutrition and body composition Medication concordance Tobacco & alcohol Long term Skills beyond CR Returning to ADLs Final assessment and long term goals

Expert Advisory Group What a bunch of good looking people! Not to mention talented and experienced. We have tried to include: CR clinicians- including cardiologist and diverse range of professions included (EP, PT, psychology) Academics ACRA representation HF representation National membership + input from other content experts along the way – such as pharmacist, QUIT etc.

Standardisation – Delphi process Core deliverables Desirable Median score 8 – 9, without disagreement Median score 5 – 7, without disagreement Aware that not all programs have access to the same things. When developing this really keep in mind of the small rural program with limited resources Describe two round Delphi process via Qualtrics and second round includes teleconference meeting

CR projects around Australia 9.5.18 Opportunity to scope what is happening in the Australian CR space currently Opportunity to take this work further, both in Vic and expand nationally The time is perfect – national working parties already formed for other projects and could move forward with next stream of work

What next? National approach Governance National CR guidelines National quality indicators Monitoring of quality of care delivery (e.g. registry) What next? Not just in terms of this project but in terms of Cardiac Rehabilitation in Australia? The challenge for all of us here at this conference and all in the CR community is how can we draw all of this together Climate is good. CR is priority for HF. HF now national entitiy. National CR discussions already beginning. Next steps: Governance National CR guideline – that is embedded within ACS / cardiac guidelines National Qis – we are seeing some progress in this area with a national meeting scheduled in the next few months Auditing and monitoring – requires a registry

Guidelines Audit Governance Quality indicators Registry Quality improvement 2002 Development of stroke guidelines 2007 Established the National Stroke Audit Program (now run by AusDaT) 2008 ASC established bringing together an alliance of organisations with the common missing of improving stroke care 2008 Developed national quality indicators 2009 Australian Stroke Clinical Registry (AuSCR) was piloted Ongoing Can we follow in the footsteps of stroke rehabilitation? Over the last two decades Stroke have been developing guidelines, auditing rehabilitation, and now have a very well established registry and ongoing health reform initiatives. Crucial to this success was strong governance, a national strategic plan, coordinated advocacy and a common voice. Stroke have been able to implement these things- and have a blueprint for success. We should be planning to follow a similar process which is driven at a national level

Acknowledgements Expert Advisory Group: Ms Emma Boston Professor Robyn Gallagher Ms Kim Gray Dr Adrienne O’Neil A/Prof Julie Redfern Ms Cate Ferry Mrs Beth Meertens A/Prof Nick Cox Dr Bridget Abell Prof Lis Neubeck Dr Carolyn Astley Prof Robyn Clark Ms Maria Sheehan Mr Stephen Woodruffe Dr Rosemary Higgins Additional content specialists Ms Sian Armstrong Ms Cia Connell Sarah White

Questions. Project manager: Kerry. Hollier@heartfoundation. org Questions? Project manager: Kerry.Hollier@heartfoundation.org.au Deakin IPAN: susie.cartledge@deakin.edu.au emma.thomas1@unimelb.edu.au