Imperial College Healthcare's cardiovascular prevention and rehabilitation programme (CPRP) comprises a hospital-based programme at Charing Cross Hospital and a community-based programme (MyAction) in Westminster.
The dedicated full-time multidisciplinary team offers a comprehensive menu-based rehabilitation programme that meets the needs of its local community as well as that of a leading tertiary referral centre for coronary revascularisation, heart failure and implantable devices.
It serves 400,000 people living in Hammersmith, Fulham and Westminster, where over a quarter of people are from black and minority ethnic groups and receives referrals for over 1,300 people annually.
Aims and objectives
- to offer cardiac rehabilitation programmes designed to motivate people to attend and complete the programme. Explain the benefits of attending.
- begin cardiac rehabilitation as soon as possible after admission and before discharge from hospital. Invite the person to a cardiac rehabilitation session taking place within 10 days of their discharge from hospital.
Our cardiac prevention and rehabilitation programmes aims to provide patients with cardiovascular disease with a high quality comprehensive cardiovascular prevention and rehabilitation programme. The programme includes an emphasis on healthy lifestyle change (smoking cessation, adhering to a cardio-protective diet and increasing physical activity levels), managing medical risk factors such as blood pressure and lipids and ensuring patients are prescribed evidence-based doses of cardio-protective medications. The programme also addresses psychosocial health.
The programme is delivered by a full multidisciplinary team as per the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) Core Components and Standards (2012) which includes cardiovascular specialist nurses, dieticians, physical activity specialists supported by psychologists and a consultant cardiologist.
Reasons for implementing your project
The MyAction Westminster programme was commissioned directly by NHS Westminster in 2009 and is an integrated prevention programme including patients with all manifestations of atherosclerotic disease (including TIA/PAD) as well as patients at high multifactorial risk of developing CVD.
NICE guidance (CG48) published in May 2007 (MI - secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction) had a key priority for implementation that "Cardiac rehabilitation should be equally accessible and relevant to all patients after an MI, particularly people from groups that are less likely to access this service. These include people from black and minority ethnic groups, older people, people from lower socioeconomic groups, women, people from rural communities and people with mental and physical health comorbidities." Both programmes have been developed following this guidance as well as the relevant guidelines and targets as set out by the NSF and the Joint British Societies' recommendations on prevention of coronary heart disease in clinical practice and the BACPR Standards and Core Components for Cardiac Rehabilitation 2012. The programmes are now designed to deliver the standards set out in the updated guidance NICE (CG172) Post Myocardial infarction: secondary prevention of myocardial infarction in primary and secondary care. These have reinforced the importance of offering cardiac rehabilitation programmes designed to motivate people to attend and complete the programme, and to begin cardiac rehabilitation as soon as possible after admission and before discharge from hospital (1.1.7). The new guidance sets a target of offering a cardiac rehabilitation session within 10 days of hospital discharge (1.1.13).
How did you implement the project
The programme has a dedicated database and a strong emphasis is placed on audit and evaluation. Audit includes all clinical outcomes including lifestyle (smoking, diet, physical activity/fitness), blood pressure, lipids, glycaemia, cardio-protective medication and psychosocial measures (hospital anxiety and depression scores, quality of life measures).
In comparison with National Audit of Cardiac Rehabilitation, the programmes clinical outcomes are substantially better and show improvements across all these domains.
Patient satisfaction rating are measured using a hand held tablet device and are very positive with ratings that are in the top 5% of Imperial's services.
The Imperial cardiac and rehabilitation programme was recognised as one of the top three in the UK in the 2011 British Heart Foundation Celebrating Cardiac Rehab award. The MyAction Westminster programme was also shortlisted for a NHS Innovation and Improvements Award in 2010, by the HSJ (Health Service Journal) awards 2012 in the primary care and community service redesign category and also for an I Care Integration award in 2013. It was also commended in the BUPA Foundation Healthy Lives prize in 2011.
Key learning points
- a dedicated business case so that funding is appropriate to deliver a quality service.
- a robust identification and referral service for in patients delivered by a core member of the Cardiac Prevention and Rehabilitation programme multi-disciplinary team.
- a full multi-disciplinary team as recommended by the British Association for Cardiovascular Prevention and Rehabilitation Standards 2012 with adherence to the seven standards advocated within.
- a strong emphasis on audit and evaluation to show clinical benefit and value for money.