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Swedish cardiac rehabilitation programmes; a descriptive nationwide analysis - the perfect CR study

Session Time to go to rehab - Best of cardiac rehabilitation

Speaker Halldora Ogmundsdottir Michelsen

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Moderated Posters

Authors : H Ogmundsdottir Michelsen (Malmo,SE), E Hagstrom (Uppsala,SE), I Sjolin (Malmo,SE), M Schlyter (Malmo,SE), A Kiessling (Stockholm,SE), C Held (Uppsala,SE), E Hag (Jonkoping,SE), L Nilsson (Linkoping,SE), A Schiopu (Malmo,SE), MJ Zaman (Norfolk,GB), M Leosdottir (Malmo,SE)

Authors:
H. Ogmundsdottir Michelsen1 , E. Hagstrom2 , I. Sjolin1 , M. Schlyter1 , A. Kiessling3 , C. Held2 , E. Hag4 , L. Nilsson5 , A. Schiopu1 , M.J. Zaman6 , M. Leosdottir1 , 1Lund University, Department of Cardiology, Skane University Hospital and Department of Clinical Sciences - Malmo - Sweden , 2Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center - Uppsala - Sweden , 3Danderyd University Hospital, Department of Clinical Sciences - Stockholm - Sweden , 4Ryhov County Hospital, Department of Internal Medicine - Jonkoping - Sweden , 5Linkoping University, Department of Medical and Health Sciences - Linkoping - Sweden , 6James Paget University Hospital, Department of Cardiology - Norfolk - United Kingdom ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1032

Background: The core components of cardiac rehabilitation (CR) after myocardial infarction (MI) are well established. A multidisciplinary approach with a view to prevent future coronary events via exercise, cardioprotective medication and lifestyle changes is the recommended form of delivery. How CR is implemented in real-world settings is less well known.

Purpose: To evaluate the processes within CR programmes on a national level offered at Swedish CR centres.

Methods: CR protocols followed in Sweden in 2016 were analysed using a 120-item questionnaire which was completed by all 79 CR centres in Sweden. Results were analysed using descriptive statistics.

Results: Almost all centres (95%) reported having the required core CR professions (cardiologist, nurse and physiotherapist) in their team. Additionally, 87% had a dietician and 71% a psychologist or counsellor linked to the team. Regular team meetings were held at 76% of the clinics to discuss, for example, quality of care and work routines. Only 40% reported having regular rounds where nurses discussed patient cases with the cardiologist.

All centres reported offering patients an individual post-discharge assessment with a CR nurse, of which the majority (89%) did so within 3 weeks from discharge. At 81% of the centres patients were routinely offered an individual assessment with a CR physiotherapist. Hospital-based physical exercise was offered to patients at 95% of centres. There was considerable variation in the content of the first nurse assessment between centres (Figure 1). All centres reported discussing the patient's current medical regime with the patient at the first nurse visit. However, only 58% reported giving patients a copy of their risk factor values (blood pressure, blood test results, etc.) and only 47% handed out written information on therapeutic goals for risk factors and lifestyle changes. Systematically re-evaluating the patients' risk factor levels/goals at subsequent visits was reported as a routine at 77% of the centres.

At 79% of the centres interactive group education was offered to patients and 25% reported using web-pages or smartphone applications for patient education purposes. At 11% of the centres, no patient education apart from that given at individual counselling sessions was provided. Almost all centres (92%) reported using the Swedish Secondary Prevention after Heart Intensive Care Admission Registry (SEPHIA) for quality control and improvement. However, only 60% report to do so regularly.

Conclusion: There is a wide variation in the services provided for post-MI patients at Swedish CR centres, with considerable room for improvement. Areas of potential improvement include assessment and follow-up of established risk factors, providing written information to patients on therapeutic goals, more variety in patient education and regular use of registry data to improve quality of care.

Figure 1

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