4033A way forward for cardiac rehabilitation - Nurse clinics with active holistic patient management

Abstract

Abstract Background Early cardiac rehabilitation (CR) nurse follow up clinics 2- 3 weeks post hospital discharge have been instituted at our Hospital for all patients with established coronary artery disease to improve patient engagement and adherence. In the last 2 years these clinics have increased in attendance rates and patient complexity. These now have medical supervision, allowing for active management of patients. Patients are seen multiple times to maximize evidence based treatments by the same nurse. Risk factors are addressed in these clinics and patients are invited into cardiac rehabilitation education classes and individualized prescribed exercise programmes. Purpose To assess rates of adherence and intervention in CR nurse clinics. Methods The CR team at our Hospital has prospectively recorded rates of adherence and interventions at Nurse Specialist clinics over a 12 month period. Results 718 (94%) patients attended CR nurse clinics following discharge. Of these 413 (57%) patients had an intervention in clinic: up titration was 38% for RAAS/beta blocker, 11% for statin and 18% for antianginal and BP medication. A further 21% were referred for further investigations or treatments including admission to hospital. 48% (Standard deviation 11%) attended a cardiac rehabilitation programme in addition to these 1 hour clinics. Interventions in clinic Conclusion Nurse Specialist clinics with medical supervision that are scheduled early post discharge provide a safety net for patients who are discharged following short hospital stays. They also lead to increased prescription of secondary prevention medication and ensure patients have appropriate investigations and referrals. These clinics have resulted in change in practice with routine doctor follow up clinics now cancelled. Long term follow-up for patients is now rationalized and has freed up doctor clinics for more complex patients. Early and intensive engagement with patients is also associated with higher uptake of cardiac rehabilitation programs. Acknowledgement/Funding None