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A Community Exercise Program in Partnership with Te Hononga o Tamaki Me Hoturoa- a Holistic Approach to Exercise Rehabilitation
S36
Abstracts
P63
In anticipation of new contemporary equations being available specifically for New Zealanders and a need to update our own guidelines, a systematic review was conducted looking at current international guidance and practice for the medical management of CVD Risk. Methods: The review focussed on recent quality assured international guidelines and systematic reviews published since the Primary care Handbook update in 2012, which included CVD risk assessment and management. It was outside the remit and scope of the review to look at individual trials or studies. The focus was on the primary prevention of CVD events and management of risk factors. Results/Conclusions: Fourteen international quality assured guidelines and six systematic reviews were identified and reviewed. A full summary of the results will be presented including: A variety of thresholds for considering or recommending whether to treat medically with some using CVD Risk, some using individual risk values and others using a combination - NZ’s higher CVD Risk threshold for considering or recommending medications to treat at approximately double the risk of contemporary international guidelines - Most recommend tailoring medications to reach a target but some not - When treating to a target varying views on what those targets should be - Equivocal views on risk communication and medication adherence - Identification of mental health as a CVD risk factor
A Community Exercise Program in Partnership with Te Hononga o Tamaki Me Hoturoa- a Holistic Approach to Exercise Rehabilitation Cathy Gasparini 1*, Yvonne Johansen 1, Susan Reed 1, Wendy Marshall 1, Jocelyne Benatar 1, Sugar Te Paa 2, Nathan Armstrong 2, Lisa Moodie 1 1
Auckland DHB, Auckland, New Zealand Te Hononga o Tamaki me Hoturoa, Auckland, New Zealand * Corresponding author. 2
Background: Community based cardiac rehabilitation programs are considered best practice post-cardiac event. Uptake of exercise cardiac rehabilitation is generally low across New Zealand, with Tangata whenua and Pacific Islanders most at risk of non-participation. Delivering guideline based exercise programs in the community is also problematic with difficulty in providing sufficient staff with relevant qualifications to support patients. Methods: The cardiac rehabiliation team at the Auckland District Health Board developed a community-based exercise program in the Mt Albert region in partnership with physiotherapists and the local Whanau Ora provider, Te Hononga in July 2015. The program comprises an 8-week program, with twice weekly exercise sessions for 1 hour that is able to accommodate 12 patients per session. The aim was to increase participation of Maori and to incorporate the holistic whanau ora approach to cardiac rehabilitation. Results: Te Hononga have worked alongside ADHB staff to supervise the prescribed exercise program and have helped facilitate Maori and Pacific patients to attend the program. The Te Hononga MDT of Registered Nurses, Lifestyle coaches and social workers in addition provide support through Phase 2 and 3 to Maori and Pacific clients to achieve long-term adherence to lifestyle changes. As this program is run in a community gym, this has empowered patients to continue with exercise in a public gym beyond the phase 2 program. Conclusion: This innovate holistic approach to exercise has facilitated the transition from phase 2 to long-term management of risk factors for heart disease for the most vulnerable patients. The partnership with the Whanau Ora provider has provided a more patient centric approach to the program. http://dx.doi.org/10.1016/j.hlc.2016.05.093 P64 Primary Prevention of Cardiovascular Disease – What Happens in the Rest of the World? Fraser Hamilton *, Gerry Devlin, Kim Arcus Heart Foundation, Auckland, New Zealand * Corresponding author. Background: Risk management thresholds for medication commencement for primary prevention of cardiovascular disease (CVD) remains controversial. Recent guidelines released in the UK and the United States (e.g. UK NICE and ACC/AHA guidelines) have added to this.
http://dx.doi.org/10.1016/j.hlc.2016.05.094 P65 Treatment Predicts Who Attends Cardiac Rehabilitation- Are We Underplaying CAD that is Medically Managed? Yvonne Johansen *, Wendy Marshall, Susan Reed, Cathy Gasparini, Jocelyne Benatar Auckland DHB, Auckland, New Zealand * Corresponding author. Background: Evidenced-based cardiac rehabilitation (CR) programs reduce mortality and morbidity in patients post cardiac events. Uptake of cardiac rehabilitation is generally poor with 30% uptake worldwide. Methods: A retrospective audit of all patients discharged from Coronary Care, Ward 38 or Ward 42, Auckland City Hospital between 1/10/14 and 31/3/15 with a diagnosis of acute coronary syndrome (ACS) eligible for cardiac rehabilitation was undertaken. The ANZACS QI entry, discharge summaries, and attendance at cardiac rehabilitation nurseled clinics and community-based education classes were reviewed. Results: 276 patients were discharged with ACS from Auckland District Health Board (ADHB) and 167 belonged to the ADHB. 87% of these patients attended a CR nurse clinic and 50% attended a CR program. A diagnosis of ST elevation myocardial infarction (STEMI) and non- STEMI slightly predicted uptake of CR (45.7 vs 50.6%, p = 0.08). The management of ACS was highly
Abstracts
P63
In anticipation of new contemporary equations being available specifically for New Zealanders and a need to update our own guidelines, a systematic review was conducted looking at current international guidance and practice for the medical management of CVD Risk. Methods: The review focussed on recent quality assured international guidelines and systematic reviews published since the Primary care Handbook update in 2012, which included CVD risk assessment and management. It was outside the remit and scope of the review to look at individual trials or studies. The focus was on the primary prevention of CVD events and management of risk factors. Results/Conclusions: Fourteen international quality assured guidelines and six systematic reviews were identified and reviewed. A full summary of the results will be presented including: A variety of thresholds for considering or recommending whether to treat medically with some using CVD Risk, some using individual risk values and others using a combination - NZ’s higher CVD Risk threshold for considering or recommending medications to treat at approximately double the risk of contemporary international guidelines - Most recommend tailoring medications to reach a target but some not - When treating to a target varying views on what those targets should be - Equivocal views on risk communication and medication adherence - Identification of mental health as a CVD risk factor
A Community Exercise Program in Partnership with Te Hononga o Tamaki Me Hoturoa- a Holistic Approach to Exercise Rehabilitation Cathy Gasparini 1*, Yvonne Johansen 1, Susan Reed 1, Wendy Marshall 1, Jocelyne Benatar 1, Sugar Te Paa 2, Nathan Armstrong 2, Lisa Moodie 1 1
Auckland DHB, Auckland, New Zealand Te Hononga o Tamaki me Hoturoa, Auckland, New Zealand * Corresponding author. 2
Background: Community based cardiac rehabilitation programs are considered best practice post-cardiac event. Uptake of exercise cardiac rehabilitation is generally low across New Zealand, with Tangata whenua and Pacific Islanders most at risk of non-participation. Delivering guideline based exercise programs in the community is also problematic with difficulty in providing sufficient staff with relevant qualifications to support patients. Methods: The cardiac rehabiliation team at the Auckland District Health Board developed a community-based exercise program in the Mt Albert region in partnership with physiotherapists and the local Whanau Ora provider, Te Hononga in July 2015. The program comprises an 8-week program, with twice weekly exercise sessions for 1 hour that is able to accommodate 12 patients per session. The aim was to increase participation of Maori and to incorporate the holistic whanau ora approach to cardiac rehabilitation. Results: Te Hononga have worked alongside ADHB staff to supervise the prescribed exercise program and have helped facilitate Maori and Pacific patients to attend the program. The Te Hononga MDT of Registered Nurses, Lifestyle coaches and social workers in addition provide support through Phase 2 and 3 to Maori and Pacific clients to achieve long-term adherence to lifestyle changes. As this program is run in a community gym, this has empowered patients to continue with exercise in a public gym beyond the phase 2 program. Conclusion: This innovate holistic approach to exercise has facilitated the transition from phase 2 to long-term management of risk factors for heart disease for the most vulnerable patients. The partnership with the Whanau Ora provider has provided a more patient centric approach to the program. http://dx.doi.org/10.1016/j.hlc.2016.05.093 P64 Primary Prevention of Cardiovascular Disease – What Happens in the Rest of the World? Fraser Hamilton *, Gerry Devlin, Kim Arcus Heart Foundation, Auckland, New Zealand * Corresponding author. Background: Risk management thresholds for medication commencement for primary prevention of cardiovascular disease (CVD) remains controversial. Recent guidelines released in the UK and the United States (e.g. UK NICE and ACC/AHA guidelines) have added to this.
http://dx.doi.org/10.1016/j.hlc.2016.05.094 P65 Treatment Predicts Who Attends Cardiac Rehabilitation- Are We Underplaying CAD that is Medically Managed? Yvonne Johansen *, Wendy Marshall, Susan Reed, Cathy Gasparini, Jocelyne Benatar Auckland DHB, Auckland, New Zealand * Corresponding author. Background: Evidenced-based cardiac rehabilitation (CR) programs reduce mortality and morbidity in patients post cardiac events. Uptake of cardiac rehabilitation is generally poor with 30% uptake worldwide. Methods: A retrospective audit of all patients discharged from Coronary Care, Ward 38 or Ward 42, Auckland City Hospital between 1/10/14 and 31/3/15 with a diagnosis of acute coronary syndrome (ACS) eligible for cardiac rehabilitation was undertaken. The ANZACS QI entry, discharge summaries, and attendance at cardiac rehabilitation nurseled clinics and community-based education classes were reviewed. Results: 276 patients were discharged with ACS from Auckland District Health Board (ADHB) and 167 belonged to the ADHB. 87% of these patients attended a CR nurse clinic and 50% attended a CR program. A diagnosis of ST elevation myocardial infarction (STEMI) and non- STEMI slightly predicted uptake of CR (45.7 vs 50.6%, p = 0.08). The management of ACS was highly