Cardiac rehabilitation programmes are divided into 4 phases:
It is important is that it must be integrated across traditional sector boundaries, including secondary care, primary care, public health, local authorities and community and voluntary organisations and be appropriate to local need and preference.
Table 2 - The current provision of Phase 1-3 cardiac rehabilitation is delivered through the following providers:
Phases I and III services in the south of west Kent are delivered by specialist nurses from the acute trust. The service at Maidstone Hospital is offered on the hospital site and available mainly to post Myocaridal Infarction (MI) and surgical patients. Some heart failure patients are also offered a cardiac rehab service by the heart failure specialist nurse.
In December 2007 the service from the Kent and Sussex Hospital was devolved to the community and is now delivered in two sports centres by the specialist nurses from the acute trust. This service also concentrates on post MI and surgical patients. Some heart failure patients are also offered cardiac rehabilitation. In the future the service would like to expand to offer cardiac rehab to all cardiology patients and instigate the angina plan.
There is a limited Phase II provision
Phase I for all appropriate patients except those which have been treated at the William Harvey Hospital, the East Kent Community Services Provider conducts an in-reach programme, which means that staff from the community go into the hospitals on a regular basis and find the patients who are suitable for Phase I cardiac rehabilitation.
Phase II and III - The east Kent service now provides a broad based service offering exercise, lifestyle advice as well as counselling. The service is offered to post MI and surgical patients including PCI patients, as well as stable angina and stable heart failure. It is a community based programme delivered in community leisure centres and as well as a home based programme. All patients are offered the choice of a home or community based service.
In addition to the core cardiac rehabilitation programme which is offered, other initiatives have also been put in place, including:
Cognitive behavioural therapy (CBT) for obese patients - staff have had training on CBT for managing weight loss, and there is a specialist who runs weight loss clinics.
Expansion of home based exercise programme - this is now one of the cardiac rehab menu options.
Chair based classes run within the group exercise programme.
·Structured walks – a walking programme is run when capacity allows and there is the demand.
Increased dietetic and pharmacist input.
Counselling support for ICD patients -these patients can access any element of rehab if they are referred.
The NHS Health Check programme is an initiative which offers preventative checks to all those aged 40 -74 to assess their risk of vascular disease (heart disease, stroke, diabetes and kidney disease) followed by personalised advice and individually tailored management plus treatment as appropriate. This programme is designed to improve the detection and improve treatment of the risk factors associated with CVD.
Heart failure services
The newly formed Kent Community Health is expected to tackle the historically differing models of care across west and east Kent. West Kent has a similar geographical and population size to east Kent but fewer specialist nurses. The subsequent nurse: patient ratio is less. The nature of Heart Failure means that the patient pathway must include a Multi Disciplinary Team [MDT] meeting so that all professionals, clinicians and specialists involved in their care can communicate and ensure that the best package of care is delivered. MDTs are not as embedded in west Kent as they are in Medway and east Kent.