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Cross-sectional cardiac rehabilitation with a N urse Case Manager (GoHeart) improves risk factors, self-care and psychosocial outcomes. A 1-year follow-up study. Vibeke Brogaard Hansen 1 and Helle Terkildsen Maindal 2 - PowerPoint PPT Presentation
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Cross-sectional cardiac rehabilitation with a Nurse Case Manager (GoHeart) improves risk factors, self-care and psychosocial outcomes. A 1-year follow-up study.
Vibeke Brogaard Hansen1 and Helle Terkildsen Maindal2 Department of Cardiology, Lillebaelt Hospital Vejle, Denmark1. Health Promotion and Health Services,
Department of Public Health2, Aarhus University, Denmark
PURPOSEIn Denmark the local and regional health authorities share responsibility for cardiac
rehabilitation (CR). The aim of this study was to assess effectiveness of CR across sectors
coordinated by a Nurse Case Manager.
Figure 1. Flow chart of the cardiac multidisciplinary rehabilitation program (GoHeart)
METHODSThe Danish single-centre rehabilitation programme (GoHeart) was evaluated in a cohort
study in consecutive patients admitted to CR at Lillebaelt Hospital Vejle, DK from 2010 to
2011. The criteria for CR were the events of acute myocardial infarction or stabile angina
leading to assessment of invasive revascularisation (LVEF ≥ 45%). The rehabilitation status
was assessed at admission (phase IIa), at 3 months at discharge from hospital (phase IIb)
and at 1-year follow-up (phase III). Outcomes were cardiac risk factors measured
objectively and by self-report, stratified self-care status and self-reported psychosocial
factors (SF-12 and HADS). Intention-to-treat and predefined subgroup analysis on sex were
performed.
* Improving handoff across interdisciplinary and sectors (Shared Care); 1) Combined treadmill exercise test/Borg 15 talk test with a nurse and physiotherapist at the hospital2) A dietitian present at the educational course 33) A physiotherapist from the Municipal health center present at the final exercise training hour at the hospital4) Telephone contact to the General Practitioner (GP) by the Nurse Care Manager if a high risk individual (Chronic Care Model)
RESULTS183 of 241 (75.9%) patients were included (mean age 63.8 years). At discharge improvements
were found in total-cholesterol, LDL, functional capacities, self-care management, SF12 and in
depression symptoms (Table 1). At 1-year follow-up these outcomes were maintained; in addition
there was improvement in BMI and HDL (Table 1). Some variables deteriorated at 1 year; an
increase in diastolic blood pressure (p < 0.001) and a decrease in SF12, pcs (P < 0.01). There were
no sex differences. Correspondence: Vibeke Brogaard Hansen, md PhD. E-mail: [email protected]
CONCLUSIONCR shared between local and regional health authorities led by a NCM (GoHeart) improves risk factors,
self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up.
No differences in sex were found suggesting that GoHeart may be the CR program to enhance women
compliance which otherwise can be a challenge in cardiac rehabilitation.
Vejle Hospital- A part of Lillebaelt Hospital
Nothimg to declare
Nursing consultation and blood tests
1-2 weeks after visitation
Beforehand oral information and provided written material about cardiac rehabilitation
Intervention
Combined treadmill exercise /Borg 15 talk test with a nurse and physiotherapist *
Exercise training for 6 weeks; 1 hour 3 times a week*
Smoking counselling
Educational course 1-4 *
Diet counselling
Additional nurse/doctor consultation by need
Intervention
Exercise training for 6 weeks; 1.5 hours 2 times a week
Final Borg15 test with a physiotherapist
Smoking counselling
Lifestyle counselling
Introduction to food shopping and practised shopping
Psychotherapist consultation at need
Nursing consultation and blood tests
Doctor consultation
Telephone contact to GP if high-risk*
Stratification Stratification StratificationStratification
Table 1. Outcome after CR for cohort at admission compared to 3 months at discharge and at 1-year follow-up. Continuous clinical variable, self-care management, Short-Form 12 version 2 (SF-12v2) and Hospital Anxiety and Depression (HADS).
Admission to CR At 3 months discharge 12 months follow-up DifferencesStudy Variable 0-3 mo 3-12 mo N Mean SD N Mean SD N Mean SD P-value P-value Cardiovascular risk factors
BMI (kg/m²) 183 27.5 3.8 178 27.5 3.8 183 27.3 4.0 0.890 0.026Blood pressure (mmHg) Systolic 183 135.5 19.5 182 136.9 18.6 182 138.7 19.8 0.345 0.299 Diastolic 183 79.8 11.4 182 81.2 9.8 182 83.9 9.7 0.073 0.0005Total cholesterol (mmol/l) 183 4.2 1.0 183 3.9 0.8 183 3.9 0.7 0.000 0.316
LDL 181 2.4 0.8 183 2.1 0.6 183 2.1 0.6 0.000 0.459
HDL 181 1.3 0.5 183 1.3 0.4 183 1.4 0.4 0.130 0.027
Triclycerider 181 1.5 0.9 183 1.5 0.9 182 1.5 1.0 0.110 0.735Lifestyle behaviours Combined treadmill exercise/Borg 15 talk test
METS at Borg 15 (3.5 ml O²/kg/min) 176 7.5 1.9 100 8.3 1.3 172 8.3 2.6 0.007 0.788Psychosocial, % SD Self-care management
High 183 139 76.0 183 161 88.0 183 168.0 91.8 0.0002 0.071
Low 183 44 24.0 183 22 12.0 183 15.0 8.2 Health status SF-12 (pcs) 137 44 9.9 137 48.8 9.1 - - - 0.000 -
SF-12 (mcs) 137 50 10.8 137 52.3 8.9 - - - 0.005 -
SF-12 (pcs) - - - 141 48.7 9.2 141 47 10.4 - 0.002
SF-12 (mcs) - - - 141 53.0 8.4 141 53 9.7 - 0.899 Anxiety HADS-A < 8 161 125 77.6 161 134 83.2 161 137 85.1
0.083 0.564 HADS-A ≥ 8 161 36 22.4 161 27 16.8 161 24 14.9 Depression HADS-D < 8 161 138 85.7 161 148 91.9 161 149 92.5
0.0075 0.705 HADS-D ≥ 8 161 23 14.3 161 13 8.1 161 12 7.4
mo; monthsNo differences were found in (data not shown); HbA1c (only meaured for diabetic), medication intake, alcohol concumption (>7/14 untis per week), smoking status. Self-care management was determined after stratification; According to the Chronic Care ModelSF-12 pcs, physical component scoreSF-12 mcs, mental component score
Table 1. Outcome after CR for cohort at admission compared to 3 months at discharge and at 1-year follow-up. Continuous clinical variable, self-care management, Short-Form 12 version 2 (SF-12v2) and Hospital Anxiety and Depression (HADS).
Phase IIb Phase III Difference Mean SD Median Mean SD Median P-value
PACIC subscales
Patient activation 2.8 1.10 2.7 2.8 1.03 2.7 0.835
Delivery system design/decision support 4.0 0.84 3.0 3.9 0.88 4.0 0.140
Goal setting/tailoring 3.8 0.92 4.0 3.4 1.05 3.6 0.000
Problem solving/contextual 3.4 1.09 3.5 3.1 1.09 3.3 0.004
Follow-up/coordination 2.6 0.99 2.4 2.5 0.95 2.4 0.134
Overall PACIC score 3.3 0.76 3.3 3.1 0.82 3.1 0.001
Male n = 89 3.3 0.73 3.4 3.1 0.81 3.2 0.004 Female n = 22 3.2 0.89 3.2 2.9 0.85 3.0 0.166
Range 1 to 5 higher values indicating patient`s perception of a greater involvement in self-management and receipt of chronic care delivery
