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Cardiac Rehab UKIssue 11 – May 2008

Updated highlights from around the

UK include:

WestminsterPatients and practitioners pledge support –

Over 5,000 campaigners have signed the

petition in favour of universal cardiac

rehabilitation (CR) provision. Many letters

have been sent to MPs asking for their

support and many MPs have passed on the

campaign message to the Department of

Health.This kind of pressure can only help

in bringing forward action on CR.

Westminster Parliamentary lobby - Over

50 patients and CR practitioners

descended on Westminster to lobby their

local MPs about the need for more quality

CR provision. This gave a considerable

additional boost to the profile of CR in

Westminster, with over a dozen

parliamentary questions since tabled to

ministers. Continued on page 2

Update on the Campaign for Cardiac Rehabilitation2008 is a vital year for the National Campaign for Cardiac Rehabilitation and great progress

is already being made. We need your help to turn this into real results for heart patients.

The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk

Inside this issue� Laughing matters!

� Asian Cardiac Rehabilitation class

� Gardening for hearts and minds

The BACR has had the development of a

CR tariff on its radar for some time, but

until recently we never really knew the

scale of the task ahead.

The launch of the BACR Minimum

Standards and Core Components set the

scene for the start of negotiations with the

Department of Health (DH),

and in collaboration with

Professor Bob Lewin (NACR

team) and Mike Yates (DH),

we have managed to push

for cardiac rehabilitation (CR)

to become a priority for

future commissioning.

This has led to the

development of a DH task

group aimed at defining the tariff and also

promoting CR within the existing

commissioning framework. The process is

far from complete but the team is

optimistic about making the tariff a reality.

The next 6 months are crucial in ensuring

that the evidence for CR and cost of CR

are collated and agreed by

the DH group. We have five

pilot sites working at trying

to define the operational

aspects of the present

service provision, which

includes a coal-face

estimate of costs. The CR

tariff is being held back due

to the DH aim to have a

‘generic rehabilitation tariff ’. We have

recently, after considerable debate, won

the right to put a case for a stand alone

CR tariff.

This is far from guaranteed but we are

putting together a strong case and if

successful the group will prepare for the

next phase which is to work with the

Payment by Results (PbR) team and push

for a 2009 CR tariff. The CR tariff is closer

now than ever before and the BACR,

NACR, BHF and DH-PbR will collectively do

all they can to bring this about in 2009.

Professor Patrick Doherty, Chair of

Rehabilitation,York St. John University

[email protected] Patrick Doherty

The editorial team would like to welcome Anu Mukherjee to the team as the new

project lead and editor. Anu has recently joined the BHF and we look forward to

working with her in the future as I know she will be a real asset to the development

and production of the newsletter.

Diane Card – BHF Heart Health Co-ordinator and Content manager

for the Cardiac Rehab UK newsletter

CR Tariff

Cardiac Rehab UK May 2008

2 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk

Meetings with Minister and key

opposition MPs – A meeting was held

with Ann Keen MP, the Minister for

Cardiac Services. She was highly

supportive of the aims of the campaign,

but restated that it is up to PCTs to

deliver quality CR services. Briefings have

been held with the front bench health

teams of the Conservatives and Liberal

Democrats, who were highly receptive to

the strength of the evidence in favour of

CR. Our aim will be to get specific CR

commitments into party manifestos.

CR and the tariff system – Discussions

have taken place with the Department of

Health about including CR in the English

NHS tariff system. This is an extremely

important development as it could

massively improve the flow of funding to

CR programmes and make it more likely

that Primary Care Trusts in England will

provide quality CR.

New NICE CR commissioning toolkit –

The National Institute for Clinical

Excellence (NICE) will be launching a

cardiac rehab commissioning toolkit later

this month. That will benchmark

standards and encourage the

commissioning of quality CR programmes

by PCTs. This will provide a hook for

campaigners to draw their local PCT’s

attention to this unequivocal support

for CR.

ScotlandOn 25th March, BHF Scotland and Chest

Heart and Stroke Scotland held a reception

at the Scottish Parliament bringing together

campaigners, health professionals and

cardiac rehab patients from every corner of

the country.This reception was the focal

point for the campaign and will allow

Members of the Scottish Parliament the

chance to hear first hand what is going on

in cardiac rehabilitation. Cabinet Secretary

for Health and Wellbeing, Nicola Sturgeon,

was the keynote speaker at the event.The

reception was also the premiere for the first

showing of the Scottish Campaign vodcast,

featuring people from the Stirling Healthy

Hearts Group talking about the benefits of

cardiac rehab and how it has helped them

to live with heart disease.

Success in WalesOver 60 heart patients and health

professionals attended a cross-party

Assembly reception in Cardiff Bay at the

beginning of March – a successful event

with 24 Assembly Members, and the Health

Minister present.This event was a joint

organisational effort by the BHF in Wales

and the All Wales Cardiac Rehabilitation

Working Group as part of the ongoing

campaign in Wales. 2,000 people have

signed our petition and ministers have

faced numerous questions in the Assembly.

First Minister Rhodri Morgan has recognised

the importance of CR for heart patients (of

whom he is one).

In January 2008, a meeting was held with

Health Minister Edwina Hart. She then

announced £2m of interim funding for CR

programmes in Wales threatened by a

funding shortfall.This is a fantastic victory

for campaigners and should secure the

future of some vital programmes.

Next stepsOver the coming weeks and months there

will be new actions for campaigners to take

in support of cardiac rehabilitation as we

turn national support into local action.

Please continue to visit the campaign web

page at bhf.org.uk/cardiacrehab to get

involved. For further information on the

campaign please contact Josh Bayly, BHF

Campaigns Officer on 020 7725 0688 or

email [email protected]

Ruairi O’Connor, BHF Deputy Head of Policy

and Public Affairs

Mike Knapton and Edwina Hart

The 7th York Cardiac Care Conference in

April 2007, the launch of the National

Campaign for Cardiac Rehabilitation in

July 2007, and the opportunity to present

the situation and required solution in the

‘Shaping the Future in Cardiology’

symposium last October, led us to survey

the Cardiac Networks for their work plans

in cardiac rehabilitation.

Cardiac Networks are ideally placed to co-

ordinate service improvement across their

health communities.The West Midlands’

Standards for Cardiac Rehabilitation were

developed following the NSF to facilitate

audit and inform commissioning.The first

gap analysis informed allocation of the

original Patient Choice Revascularisation

pathway monies designated for

rehabilitation within the region. We have

led an annual revision of the standards,

and audited against them across The Black

Country Cardiac Network to reveal gaps in

service requiring commissioning. Last year,

the Health Care Commission Health Check

encouraged Trusts to assist the National

Audit of Cardiac Rehabilitation (NACR).

A 16 part questionnaire was developed

and distributed jointly by the Black

Country Cardiac Network and the Heart

Improvement Programme.Twenty nine of

the 30 Cardiac Networks sent the

questionnaire by electronic mail in July

2007, and efficiently completed responses

for provisional analysis by September

Cardiac Networks must tackle the inequity in Cardiac Rehabilitation

Cardiac Rehab UK

The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement www.improvement.nhs.uk 3

Did you hear the one about the heart

patient who was prescribed a special

diet of laughter and humour…he spent

six weeks eating heart-e-jokes? NOT the

best heart joke in the world though if it

caused you even the slightest bit of mirth

you have just taken a dose of laughter

medicine.

Laughter, and an active sense of humour,

is increasingly considered to be a creative

healing technique and recent studies

have shown that it can help protect

against heart attacks. Cardiologists at the

University of Maryland Medical Centre in

Baltimore believe that laughter may help

prevent heart disease and they found that

people with heart disease were 40% less

likely to laugh in a variety of situations

compared to people of the same age

without heart disease. 1

The old saying that 'laughter is the best

medicine’, appears to be true when it

comes to protecting your heart, says

Michael Miller, M.D., Director of the Centre

for Preventive Cardiology at the University

of Maryland Medical Centre. Dr. Miller says

"We don't know yet why laughing protects

the heart, but we know that mental stress is

associated with impairment of the

endothelium, the protective barrier lining

our blood vessels.This can cause a series of

inflammatory reactions that lead to fat and

cholesterol build-up in the coronary arteries

and ultimately to a heart attack.” 2

My own personal journey as a

‘laughologist’ started seven years ago after

graduating from university and becoming

a stand-up comedienne. At university I

studied the connection between arts and

healthcare and having read the book Dr.

Patch Adams – about a pioneer of

humour and arts in healthcare – I became

fascinated with the physiological and

psychological effects of laughter and

humour and was lucky enough to train

with Patch himself.

I have used humour and laughter as a

comedienne to help create different

emotional responses and have linked this

to research into cognitive behaviour.

I realised that thought patterns could be

broken down into a process which others

can adapt and learn for their coping

strategies as well as to improve their skills

of awareness, introspection and

evaluation. This is what I call laughology –

a new pattern of thinking that allows

individuals to look at challenges and

problems in life with a greater sense of

perspective and to gain control over their

emotions.

During the last decade more hospitals in

parts of the world have become

convinced of the therapeutic power of

humour. In the USA, humour based

approaches in hospitals have included

‘humour carts’ containing funny

videotapes, cartoons, games and props.3

Laughology is currently working with

health practitioners, applying cognitive

techniques to improve the health of both

patients and staff. It is about using these

techniques to allow people to cope with

life’s stresses and anxieties in a positive

manner, deploying humour to break

thought patterns where anxiety,

depression and stress can otherwise lead

to negative behaviours and ill health...

terrible heart-e-jokes permitting, of course.

Stephanie Davies, Creative Director

[email protected] /

www.laughology.co.uk

Cardiac Rehabilitation Service Manager1 University of Maryland medical centre news release.

www.umn.edu/news/releases/laughter.htm

2 University of Maryland medical centre news release.

www.umn.edu/news/releases/laughter.htm

3 The Humour Cart http://www.jesthealth.com/

art18jnj.html New York hospital humour co-ordinator

http://www.viahealth.org/body_departments.cfm?id

=1221

Laughing matters!

2007, to inform the ‘Shaping the Future of

Cardiology’ perspective in October.The full

results are to be presented at the British

Cardiovascular Society’s Annual Scientific

Conference in June 2008 in Manchester.

Early appreciation of the data has been

reassuring in that almost all Networks now

have cardiac rehabilitation work stream

meetings, most are following defined

standards (usually BACR), and two-thirds

have a designated Cardiologist to lead.The

same proportion have also received

BHF/NOF Cardiac Rehabilitation/

Heart Failure service funding grants.

Whilst eventual commitment to the NACR

audit is expressed by nearly all, only a

minority has so far contributed data from

across their Networks. Home based

options remain sparse at present, and

overall meeting of NSF and NICE standards

is still a minority achievement. Robust

commissioning mechanisms for cardiac

rehabilitation exist in well below half of

Networks, but 10% have revisited access to

revascularisation pathway monies with the

introduction of primary PCI.

An especial pride should be the particular

public and patient involvement (PPI) in the

majority of Cardiac Networks, and the

specific encouragement to improve

cardiac rehabilitation services in half of

Networks by their PPI approach.This

operational survey has supported Cardiac

Networks in developing their cardiac

rehabilitation work plans by sharing

practice experience, and the finding of

commitment by both professionals and

patients.The commissioning challenge

must be met and won to reduce the

persistent inequities of service.

For further information contact:

[email protected]

Dr. Jane Flint, Black Country Cardiac Network

Linda Binder, Heart Improvement Programme

“Years ago my dad had an allotment,

and when I was a boy I would help him

out. Now, years later, and following my

cardiac setbacks, I’ve started gardening

at a cardiac allotment project. I really

enjoy being out in the fresh air, having a

go, and getting to feel more confident

and fit. I also get to reap the rewards of

the allotment when the plants grow –

taking things home to eat – it’s great!”John is just one from a growing band of

people with heart problems who have

rediscovered gardening as a healthy and

absorbing activity that helps them get

their life back.

Thrive, the national charity that promotes

the advantages of gardening for everyone

with a disability, is encouraging more

people to try gardening as part of their

rehabilitation.

Of course, gardening has been used as a

therapy, or as an adjunct to therapy and

rehabilitation, in the treatment of disease

for centuries. But more than that, gardening

brings together physical exercise, fresh air,

healthy eating and new friendships.

Research has shown that increased

physical activity is associated with a lower

risk of cardiovascular and metabolic

diseases (USDHHS, 1996), and that the

introduction of horticulture as an integral

component of the cardiac rehabilitation

agenda may have significant psychosocial

benefits for participants.

The National Service Framework for

coronary heart disease (NSF CHD 2000),

plus the new National Stroke Strategy

(published in December 2007), provide

models to support the achievement in the

reduction of morbidity and mortality, as

well as providing help to service providers

to judge the quality of their services and

plan for the improvements needed.

In a report of the Chief Medical Officer

(Department of Health, 2004a) it

recommends 30 minutes of moderate

intensity physical activity on five or more

days of the week, and notes that the

scientific evidence for the health benefits

of physical activity are compelling.

Gardening can offer people a form of

rehabilitation that:-

� may already be familiar

� can be achieved at home – even in a

high-rise flat

� is accessible and affordable

� can be small-scale (a window box) or

more ambitious (an allotment)

� offers daily exercise with a purpose and

a bonus!

Thrive’s pocketbook ‘Just 30! Gardening for

hearts and minds’ is a step-by-step guide of

gardening activities for people who have

heart problems or have had a stroke.

Funded through the Department of Health,

the guide is being distributed across

rehabilitation units in England during its

launch in May 2008. Fully illustrated, it

guides you through a series of progressive

practical garden activities which can be

done at home, and are suited to improving

specific common problems such as

strength and mobility.The guide also

includes personal stories to inspire others,

contacts for further information, tool

information plus lots more.

A series of ‘Professional Day Workshops’

can be on offered for rehabilitation

professionals and carers, supported by a

dedicated website.

For more details contact Cath Rickhuss

[email protected] / Tel: 0118 988 5688 /

www.thrive.org.uk

Gardening for Hearts and Minds




Cardiac Rehab UK

19 and 20 October 2007, Alton,Hampshire

Course Tutors: Jenni Jones, AnnieHolden and Lesley Simpson

This BACR course is of great benefit to all

healthcare professionals working in the

area of cardiac rehabilitation and wishing

to develop their practice, or very

experienced individuals just wishing to

update their knowledge and skills.

The supporting materials are clear, easy to

understand and very user friendly. The

precourse reading serves as an appetiser

to the course, heightening the desire for

further knowledge, and the lectures

expand on it seamlessly. The course

manual contains detailed information of

all the topics covered in the course, and

used in conjunction with the slide

presentation booklet serves as an

invaluable resource for post course

consolidation and future reference.

The course content is delivered by the

lecturers using basic, easily digestible

language and making it accessible to all

regardless of previous experience. Jenni

Jones’ sessions on anatomy and

physiology, as a result, were not only

interesting, but fascinating.The overview

of different formulas for monitoring

exercise intensity, and the use of different

assessment tools turned a confusing issue

into a simple tool kit. The group sessions

on adapting exercise for special patient

populations gave nuggets of priceless

information whilst provoking further

discussions between delegates.The

practical sessions ended the days well,

providing fun, informative examples of

exercise circuits and warm up sessions.

The two days were well structured and

provided suitably timed breaks with

refreshments. Individual requests were

catered for where possible and if not, it

was not for the want of trying.

On completing the course I felt I walked

away with a whole set of resources that I

hadn’t possessed beforehand, plus plenty

of ideas on improving my service. Despite

having some knowledge of the topics

covered by the course before attending,

I hadn’t fully understood how to use it or

apply it appropriately to my practice. As a

nurse running a home based programme,

I had previously felt the area of exercise

prescription was purely the domain of the

physiotherapist.The course clearly

demonstrates how all healthcare

professionals can work together to achieve

the best outcomes for patients.

Suzanne Wood, Community Cardiac

Rehabilitation Nurse for Suffolk PCT

[email protected]

Course Review: BACR Introduction to exercise for healthprofessionals working with cardiac patients

CR professionals and nurses working with

heart failure (HF) patients formed a special

interest group in 2006 to work in

association with BACR and BSH to improve

rehabilitation services and the link

between CR professionals (BACR members)

and HF specialists (BSH members).

Positive developments1. Excellent collaboration and joint

working between BACR and BSH at

Council and Board level. Increased

profile of HF rehabilitation at national

meetings and professional associations.

2. Education opportunities – there are

now two new one day training

courses, for nurses and ex-professionals

run by ACPICR, in association with

BACR. Very popular and well evaluated.

� ‘Physical activity and exercise

advice for HF patients’: ACPICR in

association with BACR Information

contact for series of one day

courses run for nurses and exercise

professionals

Melanie.Reardon@southportandor

mskirk.nhs.uk and

[email protected]

3. Regional Networking – there are now a

number of regional HF rehab groups, eg

� The All Wales HF group meet

quarterly to discuss areas of HF

care and share good practice.The

group was initially instrumental in

developing a Quality Framework

for HF in Wales document. Offers

peer support/encouragement to all

interested professionals. Further

information please contact Dr

Jacky Austin

([email protected])

A newsletter will be posted on the BACR

(www.bcs.com/bacr) and BSH

(www.bsh.org.uk) websites to update

members. We hope to develop this into an

interactive communication forum

providing peer support shared practice.

Fiona Lough, Cardiovascular Health and

Rehabilitation, University College Hospital

London

[email protected]

Heart failure rehabilitation interest groupupdate to BACR Council

NHS Improvement Programme

From 1 April, the NHS Heart Improvement

Programme will join three other service

improvement teams to become NHS

Improvement.

NHS Improvement is the largest

improvement programme in England,

working with clinical networks and NHS

organisations to transform, deliver and

sustain improvements across the entire

pathway of care in cardiac, stroke, cancer

and diagnostic services.

Bringing together over eight years

practical service improvement experience

from the Heart Improvement Programme

(HIP), Cancer Services Collaborative

‘Improvement Partnership’ (CSCIP) and

Diagnostics Service Improvement (DSI)

Programme, NHS Improvement aims to

continue to test and support practical

implementation of service redesign

methods and share the learning. NHS

Improvement demonstrates a ‘how to’

approach to achieve sustainable effective

pathways and systems to improve the

efficiency and quality of NHS Service.

The existing good work of the HIP, CSCIP

and DSI will continue under the umbrella

of NHS Improvement, along with new

work implementing the national Stroke

Strategy. The Stroke Improvement

Programme will help to establish stroke

care networks, and lead work to improve

stroke services across England. This will

involve co-ordinating national

workstreams that mirror the priorities in

the strategy to help accelerate the

implementation of improvements both

within and across stroke services.

www.improvement.nhs.uk

0116 222 5184

Buckinghamshire New University

students publish early

PhD students within the Cardiovascular

Health Research Group at Buckinghamshire

New University are expected to publish

their findings in advance of submitting

their theses or shortly afterwards. Research

in cardiovascular health is often a coherent

series of empirical studies, each of which

can be written up on completion. Lynette

Hodges (PhD student 2001 – 2004)

published her work on supervised

rehabilitation in peripheral vascular disease

in 2006 and on erectile dysfunction prior to

myocardial infarction (MI) in 2007. Gavin

Sandercock (PhD student 2001 – 2004)

published his work on heart rate variability

instrumentation in 2004 and Samantha

Breen (MPhil 2004 – 2008) published her

work on cardiac rehabilitation programmes

in England in 2006. More recently, Djordje

Jakovljevic published in 2008 on

methodological comparisons to measure

cardiac output, David Nunan published in

2008 on the poor agreement of two

metabolic systems and Gay Donovan

presented a poster in Cardiff at the BACR

Conference on the physiological outcomes

of using a left ventricular assist device.

The University supports students to present

at international conferences and the above

have given oral communications in Vienna,

Cairo, Nashville, Dublin Copenhagen,

Jyvaskyla, Belgrade and Boston.

Two recent recruits to the Cardiovascular

Health Research Group include Johana

Nayoan who is currently collecting

psychological indices on post MI patients

in the Asian Heart Institute in Mumbai and

Nonsi Mathe who will be examining

coronary risk indices in rural and urban

populations in Zimbabwe.

Professor David Brodie

[email protected]

Healthy meals, healthy heart

A new cook book containing

over 60 easy to prepare

Asian recipes is now

available. Healthy meals,

healthy heart demonstrates

how you can still enjoy

biryani, your favourite curries

and even samosas, just by making some

small changes to the ingredients you use

and the way you cook them.

Stock code G362 Suggested donation £5

Keep you heart healthy

Heart information series number 25

A new booklet has been

added to the Heart

information series, Keep your

heart healthy. This booklet

aims to explain how, by

making changes to your

lifestyle, you can look after

your heart and reduce your risk of

developing certain heart conditions, such as

coronary heart disease or having a stroke.

Stock code HIS25

Kids’ and schools’ catalogue

Our brand new Kids’

and schools’

catalogue details all

the resources we

have available for

3 – 18 year olds. Stock code G66

Heart HelpLine card

For information and support on anything

heart – related call our Heart HelpLine on

0845 70 80 70. Order the HelpLine card with

a fridge magnet. Stock code M54

100 Voices

To get the real story of how it feels to live

with coronary heart disease today, we

interviewed 100 heart patients. 100 voices

is a unique glimpse into the lives of people

living with heart disease. Stock code G402

News News News News News News



How to order

Call the order line on 0870 600 6566,

email [email protected] or visit the

BHF website at bhf.org.uk/publications

BHF Publications

UPDATE

News News News News News News News News News

Help a Heart campaign 2008

This June our Help a Heart campaign is

dedicated to raising money to invest in life

saving heart research and we urgently need

volunteers to take part in House to House

collections in their area.

House to House collections are a great way

to help the BHF. It’s a wonderful way of

making friends, getting fit and meeting the

local community. It involves dropping off

and collecting back cash collection

envelopes in a local area. Collectors can

always do the collection with a friend or

family member for company.This may be a

good activity for your patients to take part

in and perhaps could even go towards their

30-a-day!

We would really appreciate it if you could

tell your patients about House to House

collections and encourage them to take

part. Volunteers are an essential part of the

Help a Heart Campaign. By knocking on

doors and talking to neighbours, volunteers

help to raise awareness and money.

Margaret Rees’s son, Hugh, died when he

was sixteen years old from heart disease.

Margaret believes that the work carried out

by the British Heart Foundation is important

not only because of the funding provided

to medical research and the support of

doctors and nurses, but also because of the

awareness that the charity raises about the

factors that contribute to heart disease,

such as an unhealthy diet and lifestyle.

And it is for this reason that Margaret values

her role as supporter and volunteer for the

British Heart Foundation in her local

community. Margaret says,‘we believe

absolutely in trying to raise money so that

in the next decade there might be some

new and remarkable treatments to help

people like Hugh.’

If you, or any of your patients are interested

in helping with our House to House

collections or supporting the Campaign,

please can you contact us on 0845 241

0976 or email [email protected].

Congratulations to Len Tate MBE

Len is a heart support group patient from

Ipswich and was awarded an MBE in the

New Years Honours list for services to

health. It was for his involvement in and

association with work at Ipswich hospital,

the local PCT and the local heart

support group.

It is a wonderful achievement for Len to

be recognised for his tireless work in his

local community.


Cardiac Rehab UK

Asian Cardiac Rehabilitation ClassThe Asian community is approximately

50 per cent more likely to suffer from

coronary heart disease with less

favourable outcomes than the majority

of the population.

Dawn Newman-Cooper, the Cardiac

Rehabilitation Co-ordinator at West Kent

Primary Care Trust, launched the Asian

Cardiac Rehabilitation programme (part of

the Heart of Community project) in

September 2007.The PCT is supported by

British Heart Foundation funding in

association with the Big Lottery.

In partnership with the Asian community,

the class started life in the Guru Nanak in

Gravesend as a separate women’s and

men’s class, delivered by an English female

instructor.

Originally perceived barriers were:

� language

� licence for Asian music to be used

� recruitment of patients

� cost effectiveness.

Six months on the classes have evolved

and have moved from the Guru Nanak at

the request of the members to a Church of

England hall for accessibility.

� Classes are of mixed gender so when

self funded they are more affordable

[funded by the BHF grant until

December 2008]

� Members enjoy the English music used

to motivate them in exercise

� The majority of the class are English

speaking or other members translate

simple instructions

� There are 17 members and the class is

growing through word of mouth

among the Asian community,

advertising and GP referrals.

Mrs Sehgal had coronary angioplasty and

stents implanted in 2004 and joined the

Asian Cardiac Rehabilitation class in

September 2007. Since then, she is more

confident to exercise and feels staying

healthy is beneficial for her heart. Mrs

Seghal is the Chairperson of the Asian

Women’s Group in Gravesend.

Naomi Coupland has been a fitness

instructor for five years, specialising in

cardiac rehabilitation for a year.

She runs five cardiac rehabilitation and gym

programmes in the area in addition to the

class exclusively for Asians.“I enjoy working

with people where exercise and healthy

eating is not really part of their lifestyle,”she

says.“The class has only been running six

months but I feel it is very much

appreciated and we are already seeing

small changes such as a reduction in

breathlessness and improvement in

co-ordination.”

Dawn Newman-Cooper

[email protected]

Naomi Coupland

NACR What do the patients think?GM&C is the best overall performer in

England in the National Audit of Cardiac

Rehabilitation (NACR).

The cardiac network takes this opportunity

to praise our cardiac rehabilitation

practitioners over Greater Manchester and

Cheshire, while freely acknowledging we

have a long way to go; not least to do

better by the female gender, our most

elderly and fragile residents, plus the black

and minority ethnic population groups we

wish to serve.What the practitioners

themselves want to feed back about NACR

includes a request for the audit to keep up

with the terminology now in use and to

say thanks for the Quality of Life

questionnaire, which some people find

such a useful aid, they wonder how they

managed without it before! They also like

having access to their own data.

If you visit our website

www.gmccardiacnetwork.nhs.uk you will

see our new network strategy,“Where do

we go from here?” (Cardiac strategy for the

years 2008-2011). Cardiac rehabilitation is

our third priority for action, pipped to the

post by functional imaging (first) and

primary angioplasty (second).

NACR also played its part here.We have

three million people to plan for, and our

network has a higher death and illness rate

for cardiac disease than almost anywhere

else.We have to be informed about what

action we are taking and, in turn, inform

our commissioners.We asked the relevant

clinical advisory group to write the case for

rehabilitation among about 30 other

interventions for prioritisation. So, a third is

very good.

But what do our leading patient

representatives think? Most patient

representatives have experienced cardiac

rehabilitation and patient support groups,

so are rehab’s most insightful allies.We

asked David Houghton and David Geldard,

both members of the network board and

big guns in their own communities of

Bolton and Rochdale, and below is a

summary of their thinking:

� wherever there’s a national audit, there’s

action, so they like the NACR

� how else would you know how strong,

or not, your rehab service is without this

audit? If you’re not doing it, get cracking

� we may have good access to cardiac

rehab in this network. But then again,

we have to. CHD is our major health

problem

� a lot of unsung heroes in support

groups provide services for patients; it’s

a shame not all PCTs look to them as

providers and help fund them

� what the NACR has done is prompt

PCTs in this area to look at rehab; said

PCTs should also look through the eyes

of the patient and then make funding

decisions in a coherent manner through

Phases I to IV

� practitioners put in more time to the job

than can be reasonably expected by

their trusts (and this can be seen in the

results)

� the uptake for heart failure patients

(where there is a service) is poor

� roll on the reaudit – we will have local

roadshows to celebrate successes and

recognise weaknesses

� good quality is accessed by a minority

of patients at present (and if everyone

attended the possible exercise

resources, organisations would have to

increase provision to meet demand)

� it is the lower socio-economic groups

who fare the worst. Hospital-based

rehab can be unnerving, or impossible

for some in need of it: provide more

choices: home, chair-based etc.

We know cardiac rehabilitation’s place in

our cardiac network, we want more,

everywhere, and we know our attitude to it

(menu-based and creative to meet diverse

needs, fix the access issues and please un-

bundle the tariff ).

Our patient representatives want to tell

readers of this article that patients think

they may be “coming to the end”when

they have their heart problem. Rehab lifts

that (especially for the depressed ones). It is

not just a therapy of exercise and

education, but one of companionship,

meeting other people and talking about

your experiences.

In short, we are showing up well in the

audit, but, effectively, NACR suggests we

could be “brilliant” (David Houghton) for

not very much money.

For more information contact Sally Wells at

[email protected]



Cardiac Rehab UK


The Spa at Beckenham in the London

Borough of Bromley, Kent is the home of

a special programme called MyAction.

In June 2007, the MyAction

multidisciplinary team, a cardiac specialist

nurse co-ordinator who is also an

independent nurse prescriber, a dietitian

and a physical activity specialist, set up

their office at the Spa.They started to

recruit patients with coronary heart disease

from the local hospital, as well as

individuals at high risk of developing

cardiovascular disease from general

practice, together with their partners, to a

preventive cardiology programme.

MyAction is the product of EUROACTION

(www.escardio.org/euroaction), a European

demonstration project in preventive

cardiology, but tailored for our NHS.

EUROACTION showed that a nurse led

multidisciplinary family based approach to

lifestyle and risk factor management can

achieve real lifestyle improvements and risk

factor reductions in coronary patients, and

those at high risk of developing

cardiovascular disease compared to the

same groups of patients and families

receiving standard care.

MyAction is the inspiration of Professor

Wood’s cardiovascular team at Imperial

College London, who are now partnering

with Steve Price and his team at the

Bromley Mytime Charitable Leisure Trust.

MyAction brings together the leisure trust

and the PCT in an evolution of the

EUROACTION model. EUROACTION

programmes were set up in hospitals for

coronary patients and their families, and in

general practice centres for individuals at

high multifactorial risk and their families.

Now MyAction has taken it one step

further by bringing these groups together

in one community facility. Unlike hospitals

and general practices, this leisure facility

has an ambiance of wellness. It has a more

encouraging environment and helps

families to adopt a healthy lifestyle where

adults and children can be physically active

and enjoy themselves.

The programme in Beckenham is the first

programme to be set up using this

innovative community model and is

serving as a valuable showcase for

interested Cardiac Networks and PCTs.

The unique features of this novel MyAction

programme are:

� leisure centre location

� co-ordinated by a nurse prescriber

supported by a dedicated dietician and

physical activity specialist/

physiotherapist

� family based

� focussed on lifestyle change

� management of other risk factors: blood

pressure, lipids and glucose

� provides an integrated care pathway for

both coronary patients and those at

high risk of developing the disease, in

the same community facility.

The central co-ordinating team and

Bromley Mytime are looking to partner

with more PCTs and leisure trusts to set up

MyAction programmes around the

country. MyAction is based on the principle

of integrating existing services, which are

commonly run separately, for different

groups of high risk patients. Our new

service promotes unified and

comprehensive preventive care.The

EUROACTION central team will provide

training, a health professional manual, a

database and family educational materials

plus support for the delivery of the

MyAction programme to a high standard

including mentoring and clinical audit.

For further information contact Annie

Holden, Manager of the MyAction

Programme, Bromley

[email protected]

Catriona Jennings, Cardiac Specialist Nurse

on behalf of the EUROACTION team

[email protected]

MyActionan innovative approach and partnership possibility to help manage patients with coronary

heart disease, individuals at high multifactorial risk and their families

My Action Team, Bromley

Training opportunities


May 2008

An Introduction to exercise for health professionals working withcardiac patientsThis two-day course aims to explore the physiological mechanisms underpinning the exercise

component of cardiac rehabilitation and apply these principles to design and delivery, using

an evidence-based approach. It has a practical emphasis and aims to assist health

professionals with useful tips and suggestions that can be implemented in future service

developments.

Please contact the individual venues below for application forms and more details:

Cramlington, nr Newcastle. 14 and 15 November 2008

Contact: Coral Hanson [email protected] / Tel: 01670 717 421 / Fax: 01670 590 648

London, University College Hospital, 27 and 28 November 2008

Contact: Lesley Gilbert [email protected] / Tel: 0207 380 9756 / Fax: 0207 380 9951

Cost: £250 to BACR members / £280 to non-BACR members (includes BACR membership)

If you are interested in hosting a “BACR introduction to exercise” course contact

[email protected]

An introduction to psychological issues for health professionalsworking in cardiac rehabilitationThis course aims to explore psychological issues that are relevant to cardiac rehabilitation and,

using an evidence-based approach, apply these principles to the design and delivery of

programmes. It has a practical emphasis and aims to assist health professionals to gain an

understanding of what could be incorporated into future service developments.

The course is open to health professionals working with cardiac patients in either a

primary or secondary health care setting (e.g. physiotherapists; specialist nurses [i.e.

cardiac rehabilitation, heart failure, diabetes]; primary care and community nurses;

occupational therapists etc). Instructors with the BACR Phase IV exercise instructors

qualification working in Phase III may find this course useful as it will develop their

clinical knowledge and understanding further. This course is designed for cardiac

rehabilitation professionals who already have some experience of working in cardiac

rehabilitation settings.

Cost: £250 to BACR members / £280 to non-BACR members

If you are interested in hosting this course please email [email protected]

BACR Phase IV exercise instructor trainingThis course provides specialist training for exercise professionals who want to prescribe and

deliver exercise programmes as part of the overall long-term management of individuals with

heart disease.This course has developed strong links between exercise professionals and

clinical professionals within the field of cardiac rehabilitation to enable a high standard of

care for the individual with heart disease. It is a highly respected course within the fitness

industry and is recognised by the Register of Exercise Professionals (REPs).

The course combines five days of course attendance with practical experience gained

through visiting a local clinically supervised cardiac rehabilitation programme. There is

comprehensive course material and students are required to pass both a written paper

and a case study viva in order to gain this well recognised qualification for exercise

professionals.

Courses are run all over the UK. For all course dates and venues please contact:

[email protected] / Tel: 01252 720640 / www.phaseiv.co.uk


Physical activity and exercise advice for the heart failure patient-nursing professionals study day (in association with BACR)This one-day study day is aimed at nursing professionals with experience of heart failure

patients to increase the awareness of the impact of physical activity and exercise in this

patient group.The day has both a case study and a practical emphasis and aims to assist

health professionals with useful tips and suggestions regarding physical activity and exercise

advice for all NYHA status patients, whether seen in the traditional cardiac rehabilitation

setting or in their own homes.

Belfast City Hospital. 9 May 2008

Maria Mooney [email protected] / Tel: 02890 263 826

Assessing, prescribing and delivering physical activity and exercise forthe heart failure patient - exercise professionals study day (inassociation with BACR) This one-day study day is aimed at physiotherapists and other exercise professionals involved

in the assessment and prescription of physical activity and exercise to heart failure patients.

Physiological mechanisms relating to heart failure will be explored and principles in exercise

prescription applied to enable adaptations in respect to co-morbidity and cardio-assistive

devices, using an evidence-based approach.

Ormskirk Hospital, West Lancashire. 14 June 2008

Melanie Reardon [email protected] / Tel 01695 656268

Wythenshawe Hospital, Manchester. 4 October 2008

Laura Burgess [email protected] / Tel 0161 291 2177

Exercise prescription: new insights and management of the complexpatient (in association with BACR)This course aims to encourage all professionals delivering the exercise component of cardiac

rehabilitation to explore current practice and guidelines. Clinical reasoning skills will be

encouraged through facilitated workshops to enable practitioners to interpret and adapt

evidence in order to manage patients whose status falls outside the recommended guidelines.

The exercise implications and practicalities of the more complex patient groups will be

explored. Consolidation of existing knowledge and further understanding will give confidence

in future practice.

The Octagon, Hull. 28 and 29 November 2008

Nicky Gilchrist [email protected] / Tel: 01482 674539

If you are interested in hosting this course or would like course dates please contact

[email protected]

Cardiac Rehab UKCardiac Rehab UK

Events, courses and conferences Manchester Heart Centre ICD Cardiac

Rehabilitation Study Day

27 January 2008

This course offers all health professionals

involved in the delivery of comprehensive

cardiac rehabilitation the opportunity to

access current evidence for ICD

implantation, knowledge of device

properties and considerations for

subsequent patient management. This

course aims to provide consolidation of

existing knowledge and further

understanding which will give confidence

in future practice.

Lecture topics include:

� criteria for ICD implantation

� implantation and device testing

� support post implantation

� questions commonly asked by ICD

patients

� psychological considerations

� exercise considerations ICD Research.

7 July 2008, Postgraduate Centre,

Manchester Royal Infirmary

Cost: £90.00 (Includes refreshments)

For further information contact: Sharon

Green, [email protected] /

Tel 0161 276 6048.

More events on back page


This is the official newsletter of the British Heart Foundation (BHF) and the British Association for Cardiac Rehabilitation (BACR).Views or opinions that appear or are expressedin articles and letters by an individual do not necessarily represent those of the BHF or the BACR and neither do the organisations endorse any products or services advertised.BHF and BACR do not accept liability for its contents or for consequences which may result from the use of information or advice given.

M88 0508 © British Heart Foundation 2008. Registered Charity Number 225971.

Events, courses and conferences Continued from previous pages

The Cardiac Rehab UKEditorial TeamContent Managers:

Linda Binder, Intern Director (NHS Heart

Improvement Programme)

Diane Card, Heart Health Co-ordinator

(British Heart Foundation)

Geoff Dorrie, Council Member (British

Association for Cardiac Rehabilitation)

Editor:

Anu Mukherjee, Project Officer,

British Heart Foundation

Cardiac Rehab UK is a free newsletter aimed

at health professionals either working in or

with an interest in cardiac rehabilitation.

To subscribe, submit an article or

contact the editorial team, email

[email protected]

Deadlines for submissions

Issue 12, September 2008, 30 June 08

Access the Newsletter online

The current issue and back copies are

available to download from

bhf.org.uk/publications

The current issue is also available via the

BACR website www.bcs.com

Cardiac and Critical Care

Organisation Cardiology

Therapeutics Conference 2008 19

and 20 September 2008

Central London

Keynote lectures following European

Society of Cardiology (ESC) and American

College of Cardiology (ACC)

Congresses:

� Acute Coronary Syndrome (prepare for

NICE 2009)

� Chronic Heart Failure update on progress

� Myocardial Infarction

� Cardiac Rehabilitation update

� Obesity, Nutrition and Cardiovascular

Disease

� Diabetes as a CV disease

� Update from Cardiovascular Network

� Stroke: New Agenda for Cardiovascular

Units and Networks

� Opportunity to network and share ideas

on Guidelines

� Opportunity to ask questions from

Expert Speakers.

For further information and enquiries

contact: [email protected] or

[email protected]

University of York innovation to

deliver on Prime Minister’s CHD

prevention agenda

The Prime Minister has once again placed

CHD prevention at the heart of the

government’s health care agenda. On the

7 January 2008 Gordon Brown outlined his

vision for preventative care by

emphasising the need for ‘personalised

prevention plans’ to be delivered by

professionals in the primary care setting.

Practitioners working with patients at risk

of CHD or living with CHD need to ensure

they are equipped to build and deliver this

preventative care agenda.

The BHF Care and Educational research

group based at the University of York had

previously identified this need and has

developed an innovative approach to

delivering the required educational

support on a national basis.

CHD Prevention Online is a 14 week

course that is delivered entirely over

the Internet.

The course uses unique video-based

patient dramas to create extremely

realistic practice experience. Practitioners

from all over the country, supported by

expert tutors at the University of York,

work with patients in the virtual

environment to assess patient’s risk of

heart disease, manage CHD risk factors

and implement personal CHD prevention

plans.

The course has been adopted nationally

by the BHF to train their new secondary

prevention nurses.

Three cohorts of practitioners have now

completed the course. They describe it as

an excellent learning experience:

Cardiac rehabilitation nurse: ‘The

availability of resources to use in practice,

the added support of the discussion

rooms and tutor access has made for a

phenomenal learning experience.’

Practice nurse: ‘Personal comments in the

course journals were always positive and

encouraging and kept me motivated.’

Coronary care nurse: ‘The virtual patients

made the learning real. These people will

live with me for a long time.’

If you think this course could benefit your

practice visit

www.york.ac.uk/healthsciences/cardiac

for more details.

Other key dates for your diary:

3-4 October 2008

BACR Conference, York. More details to

follow.

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