Reference: March 2024 | Issue 3 | Vol 10 | Page 46
Participation in a medically supervised cardiac rehabilitation programme is a Class 1A recommendation in international guidelines for all patients hospitalised after an acute cardiac event, coronary revascularisation procedure, or heart failure. Despite the sound body of evidence supporting the efficacy of the intervention, ensuring equitable and timely access to the service has been challenging in Ireland.
To combat this, the HSE is launching new developments in cardiac rehabilitation across the country, which are based on the new Model of Care for Integrated Cardiac Rehabilitation. Implementation of the model is being supported by the National Heart Programme, Integrated Care Programme for Chronic Disease, and the Enhanced Community Care Programme.
The initiative is considered a major step forward in aligning with international recommendations that will ensure patients have access to timely, high-quality cardiac rehabilitation care, regardless of where they live.
The new model was developed by the Prevention Sub-Group of the Clinical Advisory Group of the National Heart Programme in partnership with key stakeholders and reflects the Sláintecare vision. It recommends the integration of cardiac rehabilitation services across hospital and community settings to provide person-centred care by a multidisciplinary team of medical, nursing, and social care professionals.
The model also places a focus on encouraging and supporting referral to, and attendance at, cardiac rehabilitation for those who are traditionally under-referred, particularly women, older patients, and marginalised groups.
Prof J William McEvoy, Chair of the Prevention Sub-Group of the National Heart Programme and Director of the National Institute for Prevention and Cardiovascular Health, said the model “represents the culmination of years of hard work”.
“It will support the provision of optimal care for patients living with chronic cardiovascular disease in Ireland. This model of care has been developed and refined by a wide range of stakeholders within the Irish healthcare system. I acknowledge the work of all involved to make this model of care available for patient care.
“In addition, as an internationally active researcher in preventive cardiology, I can confidently say that this model of care incorporates the latest and best in evidence-based medicine. I see the publication as a further advance in improving timely access to and consistency of care for patients who require cardiac rehabilitation across the country.”
Prof Ken McDonald, HSE Clinical Lead, National Heart Programme, added: “The model sets out a robust cardiac rehabilitation service as part of an integrated framework for the prevention and management of chronic disease in Ireland, placing patients squarely at the centre of care.
The cardiac rehabilitation service will be planned around patients according to need; so as to support and empower them to optimise their health, actively address and minimise their risk factors for chronic disease, and to live well with chronic disease. The National Heart Programme endeavours to support cardiac rehabilitation professionals, as we work together to implement this.”
Summary of the model
The aim of the national Model of Care for Integrated Cardiac Rehabilitation is to review best practice in the design, delivery, monitoring, and evaluation of phases I (inpatient period), II (immediate post-discharge period), and III (structured, comprehensive prevention and rehabilitation programme) cardiac rehabilitation in Ireland. Phase IV entails the maintenance of the programme. With implementation of the model, patients can expect the following from their cardiac rehabilitation service:
STEP 1 | STEP 2 | STEP 3 | STEP 4 | STEP 5 | STEP 6 | STEP 7 |
---|---|---|---|---|---|---|
Phase I: Early inpatient contact with cardiac rehabilitation service and referral to phases II and III | Managing the referral: Supporting patient choice and engagement | Phase II: Structured phone call or home visit | Phase III: Initial assessment and development of a patient-centred care plan | Phase III: Delivery of a standardised set of cardiac rehabilitation components | Phase III: End of programme assessment and discharge. Signposting to community services to support long-term behaviour change | Evaluation of cardiac rehabilitation service – to support delivery of an equitable, high-quality, person-centred service |
Figure 1: Seven steps in the Model of Care for Integrated Cardiac Rehabilitation
- A person-centred service.
- A patient’s cardiac rehabilitation journey is tailored as much as possible to meet their specific needs.
- Early inpatient contact.
- Early contact with one or more members of the cardiac rehabilitation team during the patient’s episode of hospitalisation to begin their cardiac rehabilitation journey.
- Automatic referral to the cardiac rehabilitation service. A referral to cardiac rehabilitation should be automatically generated as part of discharge planning for all eligible patients.
- Early and standardised initial assessment.
- A standardised set of core components delivered as part of the phase III service.
- A standardised set of components, including initial assessment and development of a person-centred care plan; health behaviour change; education; lifestyle risk factor management; medical risk factor management.
- A standardised end of programme assessment and discharge planning.
- A service which measures and evaluates its service and engages in quality improvement activities.
For healthcare professionals, the model of care sets out seven key steps that must be attended to in order to deliver a high quality, integrated cardiac rehabilitation service across hospital and community (Figure 1).
The principles underpinning the model of care, as outlined in the document, are:
1. Cardiac rehabilitation programmes should be delivered by multidisciplinary teams and should offer a standard set of evidence-based core components.
2. Cardiac rehabilitation should offer a patient-centred service, with an emphasis placed on optimising patient uptake and completion of cardiac rehabilitation courses. To that end, flexibility in how, when, and where patients engage with cardiac rehabilitation services is advised.
3. Cardiac rehabilitation should be accessible in a timely and equitable manner to all eligible patients.
4. Cardiac rehabilitation should be monitored and outcomes evaluated so that quality-of-care is maintained and improved and that the service is accountable to patients.
Commenting on the new model, Dr Colm Henry, Chief Clinical Officer, HSE said: “I greatly welcome this Model of Care for Integrated Cardiac Rehabilitation, which was developed by a multi-disciplinary group, led by Prof William McEvoy, and supported by the HSE National Heart Programme and Integrated Care Programme for Chronic Disease.
The development of this is a major step forward in that it will ensure that eligible patients across the country receive standardised care, in a timely manner, and based on the best available evidence. I would like to acknowledge the work of all involved to make this model of care available for patient care to further improve the management of chronic cardiovascular disease in Ireland.”
Dr Angie Brown, Medical Director, Irish Heart Foundation, added: “The Irish Heart Foundation whole-heartedly welcomes the Model of Care for Integrated Cardiac Rehabilitation, as it is an essential component of secondary prevention of cardiovascular disease. We know from supporting and advocating for patients living with cardiovascular disease and their families that these patients need ready access to cardiac rehabilitation.
“This model of care will support healthcare professionals to provide this service and provide a mandate to fund and equip cardiac rehabilitation centres. This will have a significant impact in saving lives and improving the quality-of-life of large numbers of cardiac patients.”
The full document is available at: www.hse.ie/eng/services/publications/model-of-care-for-integrated-cardiac-rehabilitation.pdf.
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