1. Cross-sectional cardiac rehabilitation with a Nurse Case Manager (GoHeart) improves risk factors, self-care and psychosocial outcomes. A 1-year follow-up study. Vibeke Brogaard Hansen 1 and Helle Terkildsen Maindal 2 Department of Cardiology, Lillebaelt Hospital Vejle, Denmark 1. Health Promotion and Health Services, Department of Public Health 2, Aarhus University, Denmark PURPOSE In Denmark the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The aim of this study was to assess effectiveness of CR across sectors coordinated by a Nurse Case Manager. Figure 1. Flow chart of the cardiac multidisciplinary rehabilitation program (GoHeart) METHODS The Danish single-centre rehabilitation programme (GoHeart) was evaluated in a cohort study in consecutive patients admitted to CR at Lillebaelt Hospital Vejle, DK from 2010 to 2011. The criteria for CR were the events of acute myocardial infarction or stabile angina leading to assessment of invasive revascularisation (LVEF ≥ 45%). The rehabilitation status was assessed at admission (phase IIa), at 3 months at discharge from hospital (phase IIb) and at 1-year follow-up (phase III). Outcomes were cardiac risk factors measured objectively and by self-report, stratified self-care status and self-reported psychosocial factors (SF-12 and HADS). Intention-to-treat and predefined subgroup analysis on sex were performed. * Improving handoff across interdisciplinary and sectors (Shared Care); 1) Combined treadmill exercise test/Borg 15 talk test with a nurse and physiotherapist at the hospital 2) A dietitian present at the educational course 3 3) A physiotherapist from the Municipal health center present at the final exercise training hour at the hospital 4) Telephone contact to the General Practitioner (GP) by the Nurse Care Manager if a high risk individual (Chronic Care Model) RESULTS 183 of 241 (75.9%) patients were included (mean age 63.8 years). At discharge improvements were found in total-cholesterol, LDL, functional capacities, self-care management, SF12 and in depression symptoms (Table 1). At 1-year follow-up these outcomes were maintained; in addition there was improvement in BMI and HDL (Table 1). Some variables deteriorated at 1 year; an increase in diastolic blood pressure (p < 0.001) and a decrease in SF12, pcs (P < 0.01). There were no sex differences. Correspondence : Vibeke Brogaard Hansen, md PhD. E-mail: vibeke.brogaard.hansen@rsyd.dk CONCLUSION CR shared between local and regional health authorities led by a NCM (GoHeart) improves risk factors, self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up. No differences in sex were found suggesting that GoHeart may be the CR program to enhance women compliance which otherwise can be a challenge in cardiac rehabilitation. Vejle Hospital - A part of Lillebaelt Hospital Nothimg to declare Nursing consultation and blood tests 1-2 weeks after visitation Beforehand oral information and provided written material about cardiac rehabilitation Intervention Combined treadmill exercise /Borg 15 talk test with a nurse and physiotherapist * Exercise training for 6 weeks; 1 hour 3 times a week* Smoking counselling Educational course 1-4 * Diet counselling Additional nurse/doctor consultation by need Intervention Exercise training for 6 weeks; 1.5 hours 2 times a week Final Borg15 test with a physiotherapist Smoking counselling Lifestyle counselling Introduction to food shopping and practised shopping Psychotherapist consultation at need Nursing consultation and blood tests Doctor consultation Telephone contact to GP if high-risk* Stratification Table 1. Outcome after CR for cohort at admission compared to 3 months at discharge and at 1- year follow-up. Continuous clinical variable, self-care management, Short-Form 12 version 2 (SF- 12v2) and Hospital Anxiety and Depression (HADS). Admission to CRAt 3 months discharge12 months follow-upDifferences Study Variable 0-3 mo3-12 mo NMeanSDNMeanSDNMeanSDP-value Cardiovascular risk factors BMI (kg/m²)18327.53.817827.53.818327.34.00.8900.026 Blood pressure (mmHg) Systolic183135.519.5182136.918.6182138.719.80.3450.299 Diastolic18379.811.418281.29.818283.99.70.0730.0005 Total cholesterol (mmol/l)1834.21.01833.90.81833.90.70.0000.316 LDL1812.40.81832.10.61832.10.60.0000.459 HDL1811.30.51831.30.41831.40.4 0.1300.027 Triclycerider1811.50.91831.50.91821.51.00.1100.735 Lifestyle behaviours Combined treadmill exercise/Borg 15 talk test METS at Borg 15 (3.5 ml O²/kg/min)1767.51.91008.31.31728.32.60.0070.788 Psychosocial, % SD Self-care management High 18313976.018316188.0183168.091.80.00020.071 Low1834424.01832212.018315.08.2 Health status SF-12 (pcs)137449.913748.89.1---0.000- SF-12 (mcs)1375010.813752.38.9---0.005- SF-12 (pcs)---14148.79.21414710.4-0.002 SF-12 (mcs)---14153.08.4141539.7-0.899 Anxiety HADS-A < 816112577.616113483.216113785.1 0.0830.564 HADS-A ≥ 81613622.41612716.81612414.9 Depression HADS-D < 816113885.716114891.916114992.5 0.00750.705 HADS-D ≥ 8 1612314.3161138.1161127.4 mo; months No differences were found in (data not shown); HbA1c (only meaured for diabetic), medication intake, alcohol concumption (>7/14 untis per week), smoking status. Self-care management was determined after stratification; According to the Chronic Care Model SF-12 pcs, physical component score SF-12 mcs, mental component score

2. Table 1. Outcome after CR for cohort at admission compared to 3 months at discharge and at 1-year follow-up. Continuous clinical variable, self-care management, Short-Form 12 version 2 (SF-12v2) and Hospital Anxiety and Depression (HADS). Phase IIbPhase IIIDifference MeanSDMedianMeanSDMedianP-value PACIC subscales Patient activation 2.81.102.72.81.032.70.835 Delivery system design/decision support 4.00.843.03.90.884.00.140 Goal setting/tailoring 3.80.924.03.41.053.60.000 Problem solving/contextual 3.41.093.53.11.093.30.004 Follow-up/coordination 2.60.992.42.50.952.40.134 Overall PACIC score 3.30.763.33.10.823.10.001 Malen = 893.30.733.43.10.813.20.004 Femalen = 223.20.893.22.90.853.00.166 Range 1 to 5 higher values indicating patient`s perception of a greater involvement in self-management and receipt of chronic care delivery