Patient assessment before cardiac rehab 'critical' for personalised care
Patients are not getting essential baseline assessments at the start of cardiac rehabilitation programmes that can help improve adherence, according to experts speaking at the British Cardiovascular Society Annual Conference 2018 in Manchester this week.
7 June 2018, by Siobhan Chan
Patients entering cardiac rehabilitation are missing out on initial assessments that allow services to personalise care and can improve the number of people completing programmes, according to researchers.
Attendees at the British Cardiovascular Society (BCS) Annual Conference 2018 in Manchester this week heard how not all cardiac rehab patients receive this assessment. Researchers called for it to become routine across all UK programmes.
An assessment is one of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR)’s core components for an effective rehabilitation programme, and is needed to ‘inform the agreed personalised goals that are reviewed regularly’.
The National Audit for Cardiac Rehabilitation (NACR), commissioned by the BHF, has called for better tailoring of cardiac rehabilitation programmes for different genders, ages and ethnicities.
But providing personalised care can’t take place without the initial step of assessing patients, according to NACR Director Professor Patrick Doherty.
Speaking at the BCS conference, he said: “Personalised care should be underpinned by assessment – assessment needs to be part of the definition of cardiac rehab.
“If you don’t have an assessment, you have no idea what goals to set.”
Assessment can take place in an outpatient appointment, during a home visit or over the phone.
According to NICE, an assessment appointment is the ‘first session of a cardiac rehabilitation programme’. This session should include advice on lifestyle and risk factors and an assessment of the person's cardiac function and suitability for different components of the programme.
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Dr Simon Nichols, Senior Research Fellow in exercise physiology at Sheffield Hallam University, said that conducting an exercise assessment allows cardiac rehab professionals to determine what level of activity patients are capable of. Exercise assessments can include the six-minute walk test or incremental shuttle walk test.
“There’s a big difference in the intensity of exercise that should be prescribed to high-risk and low-risk patients,” said Dr Nichols. “But how can you risk stratify someone without having conducted a functional capacity test to begin with?”
In addition, some patients are also missing out on a final assessment on completion of cardiac rehab, according to speakers at the conference.
Professor Doherty said: “We have no idea if these patients gained anything from cardiac rehab, nor could they agree long-term goals as part of their active self-management.”
Healthcare professionals should strive to assess patients at the 12-month stage, rather than only conducting a post-cardiac rehabilitation assessment, so that longer term recovery can be tracked, he added.
NICE. (2015). Secondary prevention after a myocardial infarction
For a breakdown of the statistics behind cardiac rehab, read the NACR report 2017.
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