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PW374 The Country Access to Cardiac Health (CATCH) Program: Addressing the confounders of referral, attendance and access for rural patients post myocardial infarction
POSTER ABSTRACTS
rehabilitation in rural area where no face-to-face programs existed. As per SPAN recommendations our team is intending to offer a web based phase 2 option in the next stage of this project. Disclosure of Interest: None Declared PW374 The Country Access to Cardiac Health (CATCH) Program: Addressing the confounders of referral, attendance and access for rural patients post myocardial infarction Rosy Tirimacco1, Philip Tideman*1, Susan Jones1, Robyn A. Clark1 iCCnet, Country Health South Australia, Adelaide, Australia
PW376 A pilot study of a post-discharge nurse-led, educational intervention on cardiac selfefficacy and anxiety in post-PCI patients Katina Corones-Watkins*1, Karen Theobald2, Katherine White3, Robyn A. Clark4 1 RN, PhD Candidate, School of Nursing, 2PhD, Senior Lecturer and Study Area Coordinator, Emergency Nursing, School of Nursing, 3PhD, Postgraduate Research Coordinator, School of Psychology, Queensland University of Technology, Brisbane, 4PhD, Professor of Acute Care and Cardiovascular Research, School of Nursing and Midwifery, Flinders University, Adelaide, Australia
Introduction: There is Level 1 evidence to support cardiac rehabilitation (CR) and secondary prevention programs. However, translation of this evidence into clinical practice has been poor throughout the world with attendance rates between 10%> 40%. Common barriers identified, to ensuring that life saving secondary prevention programs research eligible patients, have mostly been health service factors such as referral, access, relevant modes of delivery (to match modern lifestyles) and linked data to evaluate outcomes. Objectives: There is Level 1 evidence to support cardiac rehabilitation (CR) and secondary prevention programs. However, translation of this evidence into clinical practice has been poor throughout the world with attendance rates between 10%> 40%. Common barriers identified, to ensuring that life saving secondary prevention programs research eligible patients, have mostly been health service factors such as referral, access, relevant modes of delivery (to match modern lifestyles) and linked data to evaluate outcomes. Methods: Metropolitan and country hospitals were instructed to refer eligible patients to the Country Access to Cardiac Health (CATCH) Program. Patients were contacted by telephone to assist them to choose and enrol in the appropriate CR delivery mode. Outcomes of the CATCH program include CR referral, attendance and completion rates, cardiac rehospitalisation and mortality. Results: To date 377 patients have been referred to the CATCH program; 192 (51%) have completed and 140 (37%) declined to participate. These data include 37 (69.8%) who have successfully completed the telephone program. Six and 12-month outcomes are on going. Conclusion: These preliminary data indicate encouraging improvements in referral, access and completion of CR and secondary prevention programs in rural areas where no CR services have existed previously. Further studies are planned to investigate the reasons why patients declined to attend CR and how to improve documentation and data retrieval for CR. Disclosure of Interest: None Declared
Introduction: Hospitalisation for percutaneous coronary intervention (PCI) is often short, with limited nurse-teaching time and poor information absorption. Currently, patients are discharged home only to wait up to 4-8 weeks to commence a secondary prevention program and visit their cardiologist. This wait is an anxious time for patients and confidence or self-efficacy (SE) to self-manage may be low. Objectives: To determine the effects of a nurse-led, educational intervention on participant SE and anxiety in the early post-discharge period. Methods: A pilot study was undertaken as a randomised controlled clinical trial. Thirtythree participants were recruited, with n¼13 randomised to the intervention group. A face-to-face, nurse-led, educational intervention was undertaken within the first 5-7 days post-discharge. Intervention group participants received standard post-discharge education, physical assessment, with a strong focus on the emotional impact of cardiovascular events and PCI. Early reiteration of post-discharge education was offered, along with health professional support with the aim to increase patients’ SE and to effectively manage their post-discharge health and well being, as well as anxieties. Self-efficacy to return to normal activities was measured to gauge participants’ abilities to manage post-PCI after attending the intervention using the cardiac self-efficacy (CSE) scale. State and trait anxiety was also measured using the State-Trait Anxiety Inventory (STAI) to determine if an increase in SE would influence participant anxiety. Results: There were some increases in mean CSE scores in the intervention group participants over time. Areas of increase included return to normal social activities and confidence to change diet. Although reductions were observed in mean state and trait anxiety scores in both groups, an overall larger reduction in intervention group participants was observed over time. Conclusion: It is essential that patients are given the education, support, and skills to selfmanage in the early post-discharge period so that they have greater SE and are less anxious. This study provides some initial evidence that nurse-led support and education during this period, particularly the first week following PCI, is beneficial and could be trialled using alternate modes of communication to support remote and rural PCI patients and extend to other cardiovascular patients. Disclosure of Interest: None Declared
PW375
PW377
1
Innovative model of care for cardiovascular patients across the continuum 1,2
2,3
3
3
Mary Boyde* , Robyn Peters , Vivian Bryce , Nicole New 1 Cardiology/Nursing Practice Development Unit, Princess Alexandra Hospital, 2School of Nursing and Midwifery, The University of Queensland, 3Cardiology, Princess Alexandra Hospital, Brisbane, Australia Introduction: Traditionally management for patients with cardiovascular disease has occurred according to their current diagnosis within distinct Cardiac Rehabilitation (CR) and Heart Failure (HF) management programs. Contemporary management of cardiovascular disease over the last decade has moved towards an integrated service based on chronic disease models. Objectives: To amalgamate the CR and HF Management Services and provide evidence based care for people across the continuum from acute care to the community. Methods: In a tertiary hospital, the Heart Recovery Service (HRS), an amalgamated multidisciplinary CR and HF management program, was established. A service profile was developed by senior CR and HF staff in consultation with Nursing Executive, Cardiologists and Allied Health Staff. Patients diagnosed with Acute Coronary Syndrome, post cardiac surgery, elective angioplasty, and HF were eligible for management by the HRS. The HRS implemented case management teams of nurses to facilitate patient centred care, peer teaching and development of advanced cardiac nursing skills. Data collection methods were established to enable evaluation of key performance indicators (referral for CR, commencement of CR education and exercise program, post discharge follow-up for HF). Results: From 1/03/2013 to 31/08/2013, 1431 in-patients were screened for eligibility for the HRS, on average 11 patients/day. Of the CR patients screened, 963 were appropriate for further CR post discharge management; 868 (90%) had a referral completed to a CR program. Of the 898 patients, 130(14.5%) were suitable for management by our HRS; 118 received telephone follow-up and of the 130, 72(55%) commenced our outpatient CR program. Mean time to follow-up was 12(5.40;range 2-44) days and mean time to commencement of this program was 34(10.19;range 9-67)days. Of the HF patients screened, 161 were referred to a HF management program: of these 98(61%) patients were suitable for our HRS; 94 received follow-up with a phone call, home visit or clinic visit. Mean time to contact post discharge was 9(2.40;range 1-32) days and 85% of patients received follow-up within 14 days. Of the 161 patients with HF 31% had a new diagnosis. Conclusion: A new patent-centred service has been established with initial results indicating the service model has resulted in achievement of key performance indicators. Disclosure of Interest: None Declared
e336
Differentials according to sex and socio-economic profile in treatment adherence and life-style modification following an acute myocardial infarction: a national survey of 536 men and women Tone Norekval*1, Yih-Kai Chan2, Melinda Carrington2, Simon Stewart2, David Thompson3 1 Institute of Medicine, University of Bergen, Bergen, Norway, 2Preventative Health, Baker IDI Heart and Diabetes Institute, 3Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia Introduction: For those fortunate to survive an acute myocardial infarction (AMI), following appropriate secondary prevention including prescribed pharmacotherapy and subscribing to long-term lifestyle changes can significantly reduce their risk of experiencing a potentially fatal secondary event. Objectives: We evaluated adherence to secondary prevention in male and female subjects of a past AMI using data from a national representative online survey. Methods: A total of 390 male (mean age 64 8 years) and 146 female (mean age 62 9 years) subjects with a past AMI completed an 20-30 minutes online validated questionnaire with outcome measures on their clinical management, pharmacotherapy concordance and lifestyle modifications following an AMI. Results: Despite being at a high risk for a secondary event, more than one third of male subjects (38%) failed to follow their doctor’s instructions and 35% occasionally forgot to take their prescribed therapy. Equivalent proportions in women were 45% and 30%, respectively. Surprisingly, one in ten (10%) subjects thought they no longer required any treatment. Side effects (18%) and cost (10%) of prescribed therapy were the two most common underlying reasons for non-compliance; particularly in women (difference w610% versus men; p<0.05). The majority of subjects expressed responsibility for (65%) and/ or had recognised the importance of a healthy lifestyle (79%) to concomitantly reduce their risk for a secondary event. However, less than half were able to adhere to their nutrition plan (43%) or were exercising regularly (32%). Overall, proportionately more women than men (83% vs. 73%; p<0.05) found lifestyle changes challenging, especially for those residing in a lower income area. For example, those living in a low income area were significantly more likely to remain physically inactive compared to those living in a high income area (66% vs. 53%; p<0.05). Conclusion: In this survey, many AMI subjects reported therapeutic inertia. A significant number were non-adherent to prescribed therapy. Moreover, adherence to a healthy lifestyle post-event remained challenging (especially for women) despite high levels of recognition of the importance of a healthy lifestyle plan. Lower socio-economic status was negatively associated with attitudes/capacity to adopt a healthier lifestyle. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
rehabilitation in rural area where no face-to-face programs existed. As per SPAN recommendations our team is intending to offer a web based phase 2 option in the next stage of this project. Disclosure of Interest: None Declared PW374 The Country Access to Cardiac Health (CATCH) Program: Addressing the confounders of referral, attendance and access for rural patients post myocardial infarction Rosy Tirimacco1, Philip Tideman*1, Susan Jones1, Robyn A. Clark1 iCCnet, Country Health South Australia, Adelaide, Australia
PW376 A pilot study of a post-discharge nurse-led, educational intervention on cardiac selfefficacy and anxiety in post-PCI patients Katina Corones-Watkins*1, Karen Theobald2, Katherine White3, Robyn A. Clark4 1 RN, PhD Candidate, School of Nursing, 2PhD, Senior Lecturer and Study Area Coordinator, Emergency Nursing, School of Nursing, 3PhD, Postgraduate Research Coordinator, School of Psychology, Queensland University of Technology, Brisbane, 4PhD, Professor of Acute Care and Cardiovascular Research, School of Nursing and Midwifery, Flinders University, Adelaide, Australia
Introduction: There is Level 1 evidence to support cardiac rehabilitation (CR) and secondary prevention programs. However, translation of this evidence into clinical practice has been poor throughout the world with attendance rates between 10%> 40%. Common barriers identified, to ensuring that life saving secondary prevention programs research eligible patients, have mostly been health service factors such as referral, access, relevant modes of delivery (to match modern lifestyles) and linked data to evaluate outcomes. Objectives: There is Level 1 evidence to support cardiac rehabilitation (CR) and secondary prevention programs. However, translation of this evidence into clinical practice has been poor throughout the world with attendance rates between 10%> 40%. Common barriers identified, to ensuring that life saving secondary prevention programs research eligible patients, have mostly been health service factors such as referral, access, relevant modes of delivery (to match modern lifestyles) and linked data to evaluate outcomes. Methods: Metropolitan and country hospitals were instructed to refer eligible patients to the Country Access to Cardiac Health (CATCH) Program. Patients were contacted by telephone to assist them to choose and enrol in the appropriate CR delivery mode. Outcomes of the CATCH program include CR referral, attendance and completion rates, cardiac rehospitalisation and mortality. Results: To date 377 patients have been referred to the CATCH program; 192 (51%) have completed and 140 (37%) declined to participate. These data include 37 (69.8%) who have successfully completed the telephone program. Six and 12-month outcomes are on going. Conclusion: These preliminary data indicate encouraging improvements in referral, access and completion of CR and secondary prevention programs in rural areas where no CR services have existed previously. Further studies are planned to investigate the reasons why patients declined to attend CR and how to improve documentation and data retrieval for CR. Disclosure of Interest: None Declared
Introduction: Hospitalisation for percutaneous coronary intervention (PCI) is often short, with limited nurse-teaching time and poor information absorption. Currently, patients are discharged home only to wait up to 4-8 weeks to commence a secondary prevention program and visit their cardiologist. This wait is an anxious time for patients and confidence or self-efficacy (SE) to self-manage may be low. Objectives: To determine the effects of a nurse-led, educational intervention on participant SE and anxiety in the early post-discharge period. Methods: A pilot study was undertaken as a randomised controlled clinical trial. Thirtythree participants were recruited, with n¼13 randomised to the intervention group. A face-to-face, nurse-led, educational intervention was undertaken within the first 5-7 days post-discharge. Intervention group participants received standard post-discharge education, physical assessment, with a strong focus on the emotional impact of cardiovascular events and PCI. Early reiteration of post-discharge education was offered, along with health professional support with the aim to increase patients’ SE and to effectively manage their post-discharge health and well being, as well as anxieties. Self-efficacy to return to normal activities was measured to gauge participants’ abilities to manage post-PCI after attending the intervention using the cardiac self-efficacy (CSE) scale. State and trait anxiety was also measured using the State-Trait Anxiety Inventory (STAI) to determine if an increase in SE would influence participant anxiety. Results: There were some increases in mean CSE scores in the intervention group participants over time. Areas of increase included return to normal social activities and confidence to change diet. Although reductions were observed in mean state and trait anxiety scores in both groups, an overall larger reduction in intervention group participants was observed over time. Conclusion: It is essential that patients are given the education, support, and skills to selfmanage in the early post-discharge period so that they have greater SE and are less anxious. This study provides some initial evidence that nurse-led support and education during this period, particularly the first week following PCI, is beneficial and could be trialled using alternate modes of communication to support remote and rural PCI patients and extend to other cardiovascular patients. Disclosure of Interest: None Declared
PW375
PW377
1
Innovative model of care for cardiovascular patients across the continuum 1,2
2,3
3
3
Mary Boyde* , Robyn Peters , Vivian Bryce , Nicole New 1 Cardiology/Nursing Practice Development Unit, Princess Alexandra Hospital, 2School of Nursing and Midwifery, The University of Queensland, 3Cardiology, Princess Alexandra Hospital, Brisbane, Australia Introduction: Traditionally management for patients with cardiovascular disease has occurred according to their current diagnosis within distinct Cardiac Rehabilitation (CR) and Heart Failure (HF) management programs. Contemporary management of cardiovascular disease over the last decade has moved towards an integrated service based on chronic disease models. Objectives: To amalgamate the CR and HF Management Services and provide evidence based care for people across the continuum from acute care to the community. Methods: In a tertiary hospital, the Heart Recovery Service (HRS), an amalgamated multidisciplinary CR and HF management program, was established. A service profile was developed by senior CR and HF staff in consultation with Nursing Executive, Cardiologists and Allied Health Staff. Patients diagnosed with Acute Coronary Syndrome, post cardiac surgery, elective angioplasty, and HF were eligible for management by the HRS. The HRS implemented case management teams of nurses to facilitate patient centred care, peer teaching and development of advanced cardiac nursing skills. Data collection methods were established to enable evaluation of key performance indicators (referral for CR, commencement of CR education and exercise program, post discharge follow-up for HF). Results: From 1/03/2013 to 31/08/2013, 1431 in-patients were screened for eligibility for the HRS, on average 11 patients/day. Of the CR patients screened, 963 were appropriate for further CR post discharge management; 868 (90%) had a referral completed to a CR program. Of the 898 patients, 130(14.5%) were suitable for management by our HRS; 118 received telephone follow-up and of the 130, 72(55%) commenced our outpatient CR program. Mean time to follow-up was 12(5.40;range 2-44) days and mean time to commencement of this program was 34(10.19;range 9-67)days. Of the HF patients screened, 161 were referred to a HF management program: of these 98(61%) patients were suitable for our HRS; 94 received follow-up with a phone call, home visit or clinic visit. Mean time to contact post discharge was 9(2.40;range 1-32) days and 85% of patients received follow-up within 14 days. Of the 161 patients with HF 31% had a new diagnosis. Conclusion: A new patent-centred service has been established with initial results indicating the service model has resulted in achievement of key performance indicators. Disclosure of Interest: None Declared
e336
Differentials according to sex and socio-economic profile in treatment adherence and life-style modification following an acute myocardial infarction: a national survey of 536 men and women Tone Norekval*1, Yih-Kai Chan2, Melinda Carrington2, Simon Stewart2, David Thompson3 1 Institute of Medicine, University of Bergen, Bergen, Norway, 2Preventative Health, Baker IDI Heart and Diabetes Institute, 3Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia Introduction: For those fortunate to survive an acute myocardial infarction (AMI), following appropriate secondary prevention including prescribed pharmacotherapy and subscribing to long-term lifestyle changes can significantly reduce their risk of experiencing a potentially fatal secondary event. Objectives: We evaluated adherence to secondary prevention in male and female subjects of a past AMI using data from a national representative online survey. Methods: A total of 390 male (mean age 64 8 years) and 146 female (mean age 62 9 years) subjects with a past AMI completed an 20-30 minutes online validated questionnaire with outcome measures on their clinical management, pharmacotherapy concordance and lifestyle modifications following an AMI. Results: Despite being at a high risk for a secondary event, more than one third of male subjects (38%) failed to follow their doctor’s instructions and 35% occasionally forgot to take their prescribed therapy. Equivalent proportions in women were 45% and 30%, respectively. Surprisingly, one in ten (10%) subjects thought they no longer required any treatment. Side effects (18%) and cost (10%) of prescribed therapy were the two most common underlying reasons for non-compliance; particularly in women (difference w610% versus men; p<0.05). The majority of subjects expressed responsibility for (65%) and/ or had recognised the importance of a healthy lifestyle (79%) to concomitantly reduce their risk for a secondary event. However, less than half were able to adhere to their nutrition plan (43%) or were exercising regularly (32%). Overall, proportionately more women than men (83% vs. 73%; p<0.05) found lifestyle changes challenging, especially for those residing in a lower income area. For example, those living in a low income area were significantly more likely to remain physically inactive compared to those living in a high income area (66% vs. 53%; p<0.05). Conclusion: In this survey, many AMI subjects reported therapeutic inertia. A significant number were non-adherent to prescribed therapy. Moreover, adherence to a healthy lifestyle post-event remained challenging (especially for women) despite high levels of recognition of the importance of a healthy lifestyle plan. Lower socio-economic status was negatively associated with attitudes/capacity to adopt a healthier lifestyle. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters