Cardiac Rehabilitation : Thinking Broadly Professor Geoffrey Tofler 19 th September 2007

Background Rehabilitation - a key ingredient for optimal management of the patient with coronary disease and heart failure. Good hospital community linkage - goal of keeping patients well in the community. Standards of care - Disease Framework Models of care may differ

S tents as an A lternative to L ytic Therapy in A cute M yocardial I nfarction

NSAHS primary angioplasty program Approximately 3,900 patients treated Average bed stay 3.2 days versus 7.2 days (lytic) Cost saving to NSAH $11,000,000 over 10 years. 200 patients “Field Triage” from 2004 Mortality 2% at 30 days

Northern Sydney Cardiac Rehab and APAC Collaboration Provide seamless continuum of care - hospital to home Facilitate early and safe discharge from the acute setting Reduce anxiety levels Improve uptake to cardiac rehab program Access a wider population by introduction of an alternative home-based model ( Helen Tsakonis, Ann Kirkness, Vanessa Baker)

ACS/PTCA Admission Seen by CR Referred to APAC Seen at home within 24 hrs post discharge Cardiac CNS Physio OTS/WPharmacist Cardiac Rehab GPCardiologist

Results of Collaboration 85% of patients referred by CR seen by APAC (n=319) Positive trend in CR attendance (50 to 60%) Lowered anxiety levels Overall very positive feedback

IMAGE GOES HERE Image only slide Ann Sullivan, Robyn Cleary, Geraldine Gillies, Susan Hales, Ingrid Pryde, Vanessa Baker

Assuming addressing cardiac med issues and extra Lasix prevented an admission, 64 x 8 x $600 = $331,000 saved 2005/6

Use of Cardiac Rehab Facilities at Ryde Hospital – Kellie Roach Cardiac Rehab sessions, includes high risk diabetic patients – 2 sessions /week Heart Failure – 3 consecutive sessions (Susan Hales) Pulmonary Rehab – 2/week (Sally Watts) Joint replacement / orthopaedic (Steven Spinatti)

Collaborative Weight Management for Coronary & Type 2 Diabetics - Ann Kirkness 70% Cardiac Rehab patients are overweight or obese, and 68% remain so at completion. Obesity - risk factor for both CAD and Type 2 Diabetes CR and Diabetic Education Centre to share existing resources and more structured approach to weight. 33 patients since Sept 2006 Mean 3.4kg weight loss at 4 months (33%≥5%) Increase physical activity (72%, 4month; 56%, 8month)

Patient not service focussed Work together across different settings and disease stages Community colleagues Cardiac Rehab link with medical teams Involve other specialties Optimal use of resources Summary