Rachel Owen CNS Cardiac Rehabilitation Cardiff & Vale UHB Lead CV Nurse South Wales Cardiac Network

Rachel Owen CNS Cardiac Rehabilitation Cardiff & Vale UHB Lead CV Nurse South Wales Cardiac Network

7 Health Boards 16 CR teams South Wales tertiary centres are Cardiff & Vale UHB and Abertawe Bro Morgannwy North Wales is the Cardiac Centre in Glan Clwyd hospital (PPCI but not 24/7) Liverpool Heart and Chest Hospital is the tertiary centre for North Wales

Heart Disease in Wales is overseen by the NHS Wales led Heart Disease Implementation Group which includes representation from health boards, third sector, British Heart Foundation and Welsh Government. Priority 4: Living with Heart Disease Drive measurable service improvement in Cardiac Rehabilitation Services to meet national standards by delivering services consistently and equitably.

Health Board Population WTE Population/W TE Abertawe Bro Morgannwy UHB 523,000 17.6 29,700 Aneurin Bevan UHB 580,400 17.59 32,900 Betsi Cadwaladr UHB 694,000 13.9 49,900 Cardiff & Vale UHB 482,000 6.3 76,500 Cwm Taf UHB 296,000 11.7 25,300 Hywel Dda UHB 384,000 14.7 26,100 Powys Teaching HB 133,000 2.9 45,800

Included in Welsh Government National Clinical Audit & Outcome Review Annual Plan 2016/17 Only one Health Board is not providing data to NACR All teams working together to improve accuracy & consistency of data collection

Uptake in Wales has increased to 42% in 2014-15 (up 4%) Consequence of 17% increase in CABG uptake, 180 extra patients Increase of 6% MI&PCI and 5% increase PCI patient groups Despite this increase Wales remain below the UK uptake rate of 47% Of concern is the low uptake of 18% following MI and elective PCI 35%

Wales N Receiving CR % MI 3,621 650 18% MI+PCI 1,506 1,282 85% PCI 1,186 413 35% CABG 788 671 85% Total 7,101 3,016 42%

Priority groups MI, MI&PCI, PCI, CABG and Heart Failure All teams have adequate referral system except for heart failure; of the 16 programmes there is not equitable heart failure CR Only 4% of patients with primary diagnosis of HF received CR

Guidelines state CR should start 28 days from referral for post MI/PCI & CABG 42 days Majority of programmes do not meet the time frames MI/PCI 25 68 days average 45 days CABG 34 58 days average 47 days

NACR demonstrated significant variation nationally in the number of pre and post assessments In Wales % starting CR with a record of pre & post assessment Pre 63% Post 33%

25 days seen as best practice & 47 days NACR average MI/PCI 40 59 days average 49 days CABG 62 107 days average 79 days

NICE & Cochrane Reviews state the duration of CR should be 12 weeks with 2 sessions per week absolute minimum to bring about positive change in health outcomes is 8 weeks, 2 sessions per week (56 days) Only 4 of the 16 programmes provide 8 weeks or above

11 of the 16 programmes had a lead name responsible for each core component Remaining 5 its assumed a member of the nursing team covers the majority Only 3 HB s offer Specialist psychological support Only 8 OT s working in CR across Wales- 2 fulltime Dieticians limited input into 7 programmes & pharmacy ad hoc

Welsh Government National Exercise Referral Scheme (NERS) work closely with local CR teams to ensure easy transition from CR programmes to leisure services Independent BACPR instructors Extend Walking for Health scheme Aqua Nordic walking programme

NACR & Baseline Review identified key areas for improvement:- Promote the impact of OT & Psychological services on patient outcomes Improve % uptake for patients attending 1 st assessment Duration of CR programmes Complete Pre & Post assessments 100% compliance to NACR Highlight deficits locally & to the Cardiac Network

June 2016 the teams in Wales agreed to work towards achieving BACPR Certification By June 2017 each team will need to demonstrate definite progress Fortunate to have Welsh representation on Certification steering group Currently 4 programmes have achieved Certification

Continue to work at All Wales level with NACR to ensure accuracy of data collection & inputting Ricky Thomas, All Wales Cardiac Informatics Manager with the Cardiac Network is working with NACR

Applying Evidence to Practice Key Messages: Clearly there are teams providing & achieving the minimum requirements and Core Components however some teams will continue to struggle without further resources Some centres are significantly understaffed that achieving Certification will be challenging Teams are exploring different ways of working to initiate service improvement All Wales CR & HF Working Group & teams are committed, dedicated & passionate who continue to strive to improve the outcome for Cardiac patients in Wales. #bacpr2016

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