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S36-3 Cardiac Rehabilitation in Indonesia
Symposia S36-2 Use of Cardiac Rehabilitation in Hong Kong? Barriers to Participation in a Phase II Cardiac Rehabilitation Program Y.M.W. Mak, C.S.S. Yue, W.K. Chan. Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China Objective: To identify barriers to phase II cardiac rehabilitation program (CRP). Methods: Cardiac patients recruited for phase I CRP over a period of seven months were studied. Reasons were explored by chart review and/or interview for those who did not join phase II. Results: Of the 193 patients recruited for phase I CRP, 152 (79%) patients, with mean age of 70.3 years (SD = 11.9), did not join phase II. Eleven (7%) deaths occurred before commencement of phase II program. Seventy-four (49%) patients were considered physically unfit with reasons included fractures, pain or degenerative changes in the lower limbs (18/74, 24%), cerebrovascular accident (14/74, 19%), chronic renal failure (8/74, 11%), congestive heart failure (7/74, 9%), and unstable angina (6/74, 8%). Phase II rehabilitation was postponed after completion of cardiac interventions in 13% of patients. Failure of physicians to arrange pre-phase II exercise stress test as per protocol was reported in 7% of patients. Work or time conflicts (16%), non-compliance with treatment (5%), financial constraints (4%), self-exercise (3%), fear after exercise stress testing (3%), and patients returning to their original cardiologists for treatment (3%) were reported. Conclusions: A significant proportion (79%) of patients did not proceed to a phase II program due to above reasons. Further study is required to look for possible solutions. S36-3 Cardiac Rehabilitation in Indonesia Basuni Radi. Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center “Harapan Kita” Jakarta, Indonesia The benefits of comprehensive cardiac rehabilitation (CR) are obvious but the facility and utilization for this service is limited. In general hospitals, CR is usually conducted as a part of general medical rehabilitation service, while risk factor control or treatment services are given by cardiologist. In National Cardiovascular Center “Harapan Kita” Jakarta, CR is conducted in a special unit that provides education, counseling, exercise program and also risk factor screening. Most participants are patients after coronary bypass surgery and join phase II hospital-based rehabilitation program for 2 weeks to 2 months only, and then they continue the phase III in home-base or community-based program. Six minute walk test is mostly used as entry test for new participants and latter on the treadmill exercise test is used to evaluate the exercise capacity. There are more than 2500 Healthy Heart Clubs all over the country that are affiliated to the Indonesian Heart Foundation. These clubs conduct and organize community-based exercise program regularly in where healthy persons can join or those with heart diseases can continue the exercise program with recommendation from a cardiologist. Conclusion: Hospital-based cardiac rehabilitation program are hardly found except in main cities but there are healthy heart clubs that organize community-based exercise program
S49 S36-4 Outpatient Cardiac Rehabilitation in Australia Ian Scott. University of Queensland, Brisbane, Australia Background: Coronary artery disease remains the most common cause of death in Western countries with most deaths occurring in patients with previous acute coronary syndromes or congestive heart failure, hence the importance of secondary prevention. Programs of outpatient cardiac rehabilitation (OCR) lower mortality but patient attendance rates are sub-optimal, with older patients with various comorbidities now comprising up 50% of those eligible for OCR. New service models are needed which overcome access and adherence barriers. Methods: A systematic review of the literature was undertaken to identify studies of OCR in the Australian context which report how new versus traditional models of OCR are being used and what results are being achieved. Results: Studies show that participation rates for traditional facility-based OCR remain less than 60%. Alternative models of OCR that have been studied include: supervised, homebased exercise programs; personalised health education by specialist nurses and individualised ‘coaching’ programs visits; nurse-run secondary prevention clinics affiliated with general practice surgeries; nurse-supervised case management; and individualised education and telephonic outreach services. Risk stratification and prioritized referral and recall systems are also being introduced. While risk factor control has improved, studies have yet to show conclusive mortality benefits. Conclusion: Access to traditional facility-based OCR remains problematic for many eligible patients. Newer models of OCR delivery which are more customized to individual patient needs and preferences have potential for optimizing secondary prevention and decreasing coronary mortality. S36-5 Cardiac Rehabilitation in Malaysia Aizai Azan Rahim. National Heart Institute, Kuala Lumpur, Malaysia Cardiac rehabilitation in Malaysia began in the mid 1980’s to complement the first coronary artery bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) which was carried out in 1982 and 1984 respectively. A multidisciplinary, comprehensive and integrated approach to cardiac rehabilitation became available in only a few public hospitals and teaching hospitals since the mid 1990’s. However, as Malaysia progressed, the incidence of coronary artery disease (CAD) increased and cardiovascular disease (CVD) soon became the leading cause of mortality in Malaysia. 25% of medically certifiable deaths are due to CVD. 17% of these deaths are from CAD and 8% are due to strokes. This resulted in the establishment of a dedicated National Heart Centre in Kuala Lumpur in 1992 to address this growing predicament. To date, there are 8 public hospitals (including university hospitals) with cardiology and cardiothoracic services and nearly 40 private hospitals and clinics with similar specialities to serve Malaysia’s population of 27 million. Most offer both Phase I and II components for post infarct, post percutaneous intervention and post surgical patients but Phase III community based program is presently only conducted by a single center run by the National Heart Foundation of Malaysia which is a Non Governmental Organization (NGO) in Kuala Lumpur. Only at the National Heart Institute do we have specific rehabilitation programs for post pacemaker, ICD patients, compensated heart failure patients and those on the heart transplant waiting list. Patients that currently benefit from these programs are those that reside within or near the
S49 S36-4 Outpatient Cardiac Rehabilitation in Australia Ian Scott. University of Queensland, Brisbane, Australia Background: Coronary artery disease remains the most common cause of death in Western countries with most deaths occurring in patients with previous acute coronary syndromes or congestive heart failure, hence the importance of secondary prevention. Programs of outpatient cardiac rehabilitation (OCR) lower mortality but patient attendance rates are sub-optimal, with older patients with various comorbidities now comprising up 50% of those eligible for OCR. New service models are needed which overcome access and adherence barriers. Methods: A systematic review of the literature was undertaken to identify studies of OCR in the Australian context which report how new versus traditional models of OCR are being used and what results are being achieved. Results: Studies show that participation rates for traditional facility-based OCR remain less than 60%. Alternative models of OCR that have been studied include: supervised, homebased exercise programs; personalised health education by specialist nurses and individualised ‘coaching’ programs visits; nurse-run secondary prevention clinics affiliated with general practice surgeries; nurse-supervised case management; and individualised education and telephonic outreach services. Risk stratification and prioritized referral and recall systems are also being introduced. While risk factor control has improved, studies have yet to show conclusive mortality benefits. Conclusion: Access to traditional facility-based OCR remains problematic for many eligible patients. Newer models of OCR delivery which are more customized to individual patient needs and preferences have potential for optimizing secondary prevention and decreasing coronary mortality. S36-5 Cardiac Rehabilitation in Malaysia Aizai Azan Rahim. National Heart Institute, Kuala Lumpur, Malaysia Cardiac rehabilitation in Malaysia began in the mid 1980’s to complement the first coronary artery bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) which was carried out in 1982 and 1984 respectively. A multidisciplinary, comprehensive and integrated approach to cardiac rehabilitation became available in only a few public hospitals and teaching hospitals since the mid 1990’s. However, as Malaysia progressed, the incidence of coronary artery disease (CAD) increased and cardiovascular disease (CVD) soon became the leading cause of mortality in Malaysia. 25% of medically certifiable deaths are due to CVD. 17% of these deaths are from CAD and 8% are due to strokes. This resulted in the establishment of a dedicated National Heart Centre in Kuala Lumpur in 1992 to address this growing predicament. To date, there are 8 public hospitals (including university hospitals) with cardiology and cardiothoracic services and nearly 40 private hospitals and clinics with similar specialities to serve Malaysia’s population of 27 million. Most offer both Phase I and II components for post infarct, post percutaneous intervention and post surgical patients but Phase III community based program is presently only conducted by a single center run by the National Heart Foundation of Malaysia which is a Non Governmental Organization (NGO) in Kuala Lumpur. Only at the National Heart Institute do we have specific rehabilitation programs for post pacemaker, ICD patients, compensated heart failure patients and those on the heart transplant waiting list. Patients that currently benefit from these programs are those that reside within or near the