Cardiac rehabilitation in Dumfries and Galloway: a model for rural areas?

Abstract

Summary Objective: To ensure that patients are not excluded from cardiac rehabilitation simply because they live at a distance from their local hospital. Design : a series of developments over six years that have included use of the Heart Manual; training of 80 community-based Heart Manual Facilitators; creation of an outreach Cardiac Rehabilitation Sister's post; development of a patient-held discharge record and follow-up form; extension of outpatient cardiac rehabilitation to six centres. Setting : Dumfries and Galloway, in south west Scotland — a predominantly rural area with a widely dispersed population of 148 000. Patients : All men and women admitted to the Medical Intensive Care Unit in Dumfries with suspected myocardial infarction. Main outcome measures : The proportion of myocardial infarction patients who received inpatient and outpatient cardiac rehabilitation, and the proportion of those discharged with a Heart Manual who received a home visit. Results : An audit of cardiac rehabilitation activity in 1994, at a time when we held outpatient classes in three centres rather than six, showed that 86% of myocardial infarction survivors received inpatient cardiac rehabilitation, and that 35% of this group completed at least five sessions of an eight-week outpatient cardiac rehabilitation class (or four or more sessions of a six-week class for over-65s). Women were as likely to receive inpatient cardiac rehabilitation as men but less likely to complete outpatient cardiac rehabilitation. Similar trends were seen for the elderly. During the latter half of 1994, 83% of myocardial infarction patients who had been discharged with a Heart Manual were visited at home by a Heart Manual Facilitator. Conclusions : We believe that our model of cardiac rehabilitation has established a vital link between hospital and community. Not only should this facilitate the universal provision of cardiac rehabilitation across a large rural area, but also it should enable patients at highest risk to be targeted for treatment. This may answer the criticism that cardiac rehabilitation programmes select only low-risk patients, for whom the benefits of cardiac rehabilitation may be marginal.