The findings of a survey of the 20 DHBs were presented by survey leader and cardiac rehabilitation nurse specialist Wendy Marshall during the recent Cardiac Society of Australia and New Zealand (CSANZ) Annual Scientific Meeting 2018.
Marshall called for cardiac rehabilitation (CR) services to be standardised across the country, with research indicating that CR programmes can reduce the risk of cardiovascular death by about 40 per cent and improve patients’ wellbeing after a cardiac event.
CR is usually delivered by nurses, but the survey, to which 19 of the 20 DHBs responded, found wide disparities in nursing resources available, as well as in the services that patients were offered in the first months after their cardiac event.
Marshall said the survey was prompted by shock at hearing from CR nurses in the northern region about how many patients they were responsible for, with services available varying widely even across greater Auckland.
The survey confirmed this, with only two DHBs having one FTE nurse for up to 250 cardiac rehabilitation patients, nine having one FTE for between 251-500 patients, and four having just one nursing FTE per 751-1000 eligible patients. (One of the 20 DHBs did not offer any CR services.)
There were also disparities in the services available, with only half the DHBs offering rehab patients individualised exercise programmes that took into account each patient’s clinical condition, and only four DHBs offering exercise programmes that met the international recommendation of 16 exercise hours or more during an eight-week CR programme.
All the DHBs offering phase 2 (post-discharge) CR programmes had education programmes, but only two-thirds offered nurse-led clinics and less than half offered psychologist and whānau ora support.
A third of the nurses surveyed said they did not specialise in CR and were also involved in a number of other cardiology services, such as pain clinics, whereas in best practice the CR nurse specialist role is a full-time position to allow for effective case management.
About 40 per cent of nurses expressed dissatisfaction with the nursing resources available to deliver CR and half were dissatisfied with the career paths available to them.
Marshall said it was up to each DHB to decide what it invested in CR and what programmes were available and the survey confirmed that this was variable. She believes CR should be standardised across New Zealand.
The profile of CR nurse specialists needs to be raised, she believes, so the specialist nurses can be used to their full potential. Having nurse-led clinics with case management of patients would free up doctor time, saving money by reducing hospital re-admissions, creating a safety net for cardiac patients, and ultimately reducing mortality.
“Cardiac rehabilitation is only a thin slice of the health budget but it has a huge impact on many lives,” said Marshall.
The findings of Marshall’s team echo a national survey carried out in 2015 and funded by the Heart Foundation and the New Zealand Cardiovascular Prevention and Rehabilitation Group, which found that variations in CR services and resources and in collecting data made it difficult to determine the effectiveness of current services.
Marshall said not only does CR save lives but comprehensive programmes also lead to: patients returning to normal life and work earlier; symptoms and issues being picked up more quickly; and patients having a greater understanding of their own health and the long-term importance of looking after themselves.
A comprehensive phase 2 (outpatients/community) CR programme in New Zealand, she said, should include: exercise programmes; education programmes covering areas such as heart disease, treatment, medication and lifestyle risk factors like hypertension, diet and weight management and smoking cessation; pharmacotherapy; management of risk factors, including blood pressure, lipids and diabetes; monitoring of symptoms; enhancement of self-management skills; and management of psychosocial issues.
The best practice for exercise programmes is that every individual undergoes an assessment and risk stratification before being given an individual exercise ‘prescription’ and referred to an individual or group exercise programme, which ideally should be at least twice a week for six to eight weeks (about 16 hours).
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