The title of the keynote lecture at this year’s NIPC National Prevention Conference in Galway was ‘Cardiac Rehabilitation – Time to Rebrand?’ and was delivered by Dr Kathy Berra of the Stanford Heart Network at Stanford University Medical School in the US. Dr Berra told the conference that cardiac rehabilitation had been around for a long time and has achieved a lot, but changes were coming.

Recently, she said, a major research paper concluded that cardiac rehabilitation programmes are the single best way to prevent and treat cardiac disease, stroke, hypertension, diabetes, obesity, smoking-related illnesses, certain cancers, depression and numerous other conditions. However, she pointed out, only about 20-30% of eligible participants ever make their way to a cardiac rehab programme.

Dr Berra said cardiac rehab professionals’ responsibilities should be expanded to include home-based and community programmes and to manage multiple disease states. Rehab centres need to become places of innovation to increase access, awareness and participation rates. These programmes, Dr Berra said, are patient-centred, interacting pro-actively with patients and their families. In spite of how well these programmes fit into the optimal model of chronic care, they have relatively few referrals, even though results show they are linked to a known reduction in all-cause mortality of between 20% and 30%.

Dr Berra cited a number of trials that reinforced the benefits of secondary prevention in heart disease management. These included the SCRIP trial carried out at Stanford in 1994, which concluded that intensive multifactor risk reduction favourably altered the rate of luminal narrowing in coronary arteries of men and women with coronary artery disease and decreased hospitalisations for cardiac events. Dr Berra says while such a conclusion would nowadays seem intuitive to most people, it wasn’t obvious back in the mid-1990s. The CHAMP study, 10 years later, found that after a secondary prevention programme with patients with diagnosed coronary disease, one year after discharge there was a significant improvement in coronary heart and mortality. Dr Berra said these and other trial results reinforced the use of clinical practice guidelines and intensive medical and lifestyle therapy in CVD. She said it was important to focus on what patients want and stressed that prevention programmes should be patient and family-focused. 

Amazing results by Croi MyAction

Referring to the recent five-year review of the Croi MyAction community-based CVD prevention programme in the west of Ireland, she said she had never seen such amazing results. It was particularly significant she said, that such programmes worked on a family basis.

Dr Berra said heart disease was very much a ‘family affair’. There is a known link between family history and heart disease; therefore, working with families was important in terms of implementing lifestyle changes in CVD prevention programmes. She said despite published guidelines, a large proportion of older patients are not receiving recommended therapies, including cardiac rehabilitation, and this needed to be addressed, as the number of elderly in the population increases.

The role of technology 

Dr Berra emphasised the role of technology in developing cardiac rehab and CVD prevention programmes. She said using IT can prove successful in CVD prevention programmes. For example, as early as 2001, research had shown that electronic self-monitoring of weight loss via email, electronic diaries to monitor progress, direct access via email to talk to a therapist and email chatrooms for support can be used successfully to maintain weight loss. 

The recent ESC conference heard details of a lifestyle focused text-messaging programme aimed at risk factor modification on patients with coronary disease, Dr Berra said. The research found a significant decrease in smoking, improved blood pressure control, a reduction in BMI, better exercise frequency and overall better management of coronary disease and atherosclerosis. Dr Berra pointed to a recent statement from the American Heart Association which indicated that although there are as yet not enough randomised clinical trials in this area to reach definite conclusions, mobile technology in CVD prevention has great potential and when added to regular healthcare, it can really help with potentially difficult aspects of care.

In conclusion, she said, cardiac rehab could be further developed into a much broader audience; “It’s time to rebrand. We need to focus on guidelines, multifactorial case management for multiple comorbidities, and we need to look at new models of care to better manage the flood of community-based patients.”

Prof Berra said we have to provide accessible and affordable programmes, focusing on the family, interfacing with telemedicine and supported by mobile technology utilising social media, texting etc. She said combining people with information technology is the way forward.