PURPOSE

1. Cross-sectional cardiac rehabilitation with a Nurse Case Manager (GoHeart) improves risk factors, self-care and psychosocial outcomes. A 1-year follow-up study. Vibeke Brogaard Hansen1 and Helle Terkildsen Maindal2 Department of Cardiology, Lillebaelt Hospital Vejle, Denmark1. Health Promotion and Health Services, Department of Public Health2, Aarhus University, Denmark Vejle Hospital - A part of Lillebaelt Hospital PURPOSE In Denmark the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The aim of this study was to assess effectiveness of CR across sectors coordinated by a Nurse Case Manager. Figure 1. Flow chart of the cardiac multidisciplinary rehabilitation program (GoHeart) • Table 1. Outcome after CR for cohort at admission compared to 3 months at discharge and at 1-year follow-up. Continuous clinical variable, self-care management, Short-Form 12 version 2 (SF-12v2) and Hospital Anxiety and Depression (HADS). Nursing consultation and blood tests 1-2 weeks after visitation Beforehand oral information and provided written material about cardiac rehabilitation Intervention Combined treadmill exercise /Borg 15 talk test with a nurse and physiotherapist * Exercise training for 6 weeks; 1 hour 3 times a week* Smoking counselling Educational course 1-4 * Diet counselling Additional nurse/doctor consultation by need Intervention Exercise training for 6 weeks; 1.5 hours 2 times a week Final Borg15 test with a physiotherapist Smoking counselling Lifestylecounselling Introduction to food shopping and practised shopping Psychotherapist consultation at need Nursing consultation and blood tests Doctor consultation Telephone contact to GP if high-risk* Stratification Stratification Stratification Stratification * Improving handoff across interdisciplinary and sectors (Shared Care); 1) Combined treadmill exercise test/Borg 15 talk test with a nurse and physiotherapist at the hospital 2) A dietitian present at the educational course 3 3) A physiotherapist from the Municipal health center present at the final exercise training hour at the hospital 4) Telephone contact to the General Practitioner (GP) by the Nurse Care Manager if a high risk individual (Chronic Care Model) METHODS The Danish single-centre rehabilitation programme (GoHeart) was evaluated in a cohort study in consecutive patients admitted to CR at Lillebaelt Hospital Vejle, DK from 2010 to 2011. The criteria for CR were the events of acute myocardial infarction or stabile angina leading to assessment of invasive revascularisation (LVEF ≥ 45%). The rehabilitation status was assessed at admission (phase IIa), at 3 months at discharge from hospital (phase IIb) and at 1-year follow-up (phase III). Outcomes were cardiac risk factors measured objectively and by self-report, stratified self-care status and self-reported psychosocial factors (SF-12 and HADS). Intention-to-treat and predefined subgroup analysis on sex were performed. RESULTS 183 of 241 (75.9%) patients were included (mean age 63.8 years). At discharge improvements were found in total-cholesterol, LDL, functional capacities, self-care management, SF12 and in depression symptoms (Table 1). At 1-year follow-up these outcomes were maintained; in addition there was improvement in BMI and HDL (Table 1). Some variables deteriorated at 1 year; an increase in diastolic blood pressure (p < 0.001) and a decrease in SF12, pcs (P < 0.01). There were no sex differences. CONCLUSION CR shared between local and regional health authorities led by a NCM (GoHeart) improves risk factors, self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up. No differences in sex were found suggesting that GoHeart may be the CR program to enhance women compliance which otherwise can be a challenge in cardiac rehabilitation. Correspondence: Vibeke Brogaard Hansen, md PhD. E-mail: vibeke.brogaard.hansen@rsyd.dk Nothimg to declare