Researchers explored multiple strategies to increase referrals to cardiac rehabilitation programs at 11 hospitals across Ontario, including using a discharge checklist for doctors, electronic referral in medical records and talking with patients at the bedside.

According to the study, “Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates”, published in the Feb. 14 edition of the journal , a combined approach – a checklist or electronic referral and talking with patients – can increase referrals by 45 per cent. By targeting both health care providers and patients, more than 70 per cent of patients enrol in cardiac rehab.

“Every patient discharged from the hospital with a heart condition should be referred to a cardiac rehab program,” says 91��ɫ kinesiology & health science Professor Sherry Grace, principal investigator and director of research for the Cardiovascular Rehabilitation & Prevention Program at the Peter Munk Cardiac Centre, which is part of the University Health Network in Toronto.

“Cardiac rehab is a key component of the continuum of cardiac care. We shouldn’t just discharge patients from the hospital without ensuring there is a link to these proven rehab services to support patients in their recovery,” says Grace.

Cardiac rehabilitation offers a comprehensive approach to health by combining medical treatments and lifestyle modification. Patients are able to benefit from a variety of services, including: education sessions, nutritional assessment with a dietitian, risk factor treatment (hypertension, cholesterol and smoking cessation) by physicians and nurse practitioners, medication review with a pharmacist, targeted exercise prescription by an exercise physiologist, nurse or kinesiologist and supervised exercise.

indicate that participating in cardiac rehab after a cardiac illness, such as a heart attack, can reduce the risk of death by approximately 25 per cent, a reduction similar to that of other standard therapies such as cholesterol-lowering medications (statins) and aspirin. In spite of this evidence, only 20 to 30 per cent of patients are referred to a cardiac rehabilitation program after hospital discharge, a phenomenon observed in many countries.

Joe Walters, 55, lost 30 pounds through the centre’s Cardiac Rehabilitation Program at Toronto Western Hospital (TWH) after having being diagnosed with an irregular heartbeat in August 2009.

“The cardiac rehab program was truly motivational. It opened my eyes to the number of people who have heart problems like me, and it was refreshing to know it came with a built-in support network,” says Walters, who notes work-related stress contributed to his weight gain and heart trouble. “I highly recommend a cardiac rehab program for anyone with a heart condition.”

Walters graduated from the program in April 2010, but continues to attend classes to keep the weight off.

Dr. Caroline Chessex, medical doctor and clinical director of the Cardiovascular Rehabilitation & Prevention Program at the centre, is part of a multidisciplinary team who treats patients like Walters by developing a personalized exercise program tailored to each patient's cardiac risk profile.

“Our goal is to develop strategies for patients to reduce or eliminate their risk of coronary artery disease, prevent or minimize hospitalization, decrease mortality and improve quality of life,” says Chessex, noting that patients can prolong their life and reduce their risk of having a second heart attack, or needing a second heart surgery.

Beyond the physical and psychological benefits, cardiac rehabilitation saves money. Cardiac bypass surgery, the most common type of open-heart surgery, costs approximately $23,000 for each patient, but rehabilitation costs $1,000 to 1,500 per patient.

“The return on investment is obvious. Focusing on expensive cardiac interventions and then discharging patients without a systematic approach for support just doesn’t make sense,” says Grace.  “Cardiac rehab is the right step towards prevention and it saves money.”

The (CIHR) and the   funded this study.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin

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That’s contrary to what most Canadians believe, says Raphael in his new book , which looks at who stays healthy, who gets sick and why. It’s written with the goal of educating the informed Canadian, as well as university students.

Most people think luck, treatment options and lifestyle choices shape whether they are healthy or not. After all, that is the current mantra – eating better and exercising will lead to a healthier existence – a mantra that Canadians have wholeheartedly internalized. But that’s only part of the equation, and not the biggest part, says Raphael, a professor in 91��ɫ's School of Health Policy & Management in the Faculty of Health.

“Decades of research and hundreds of studies in Canada and elsewhere tell a different story: the primary factors that shape the health and well-being of Canadians – the factors that will give us longer, better lives – are to be found not in those much-discussed areas, but rather in the actual living conditions that Canadians experience on a daily basis,” says Raphael in About Canada: Health and Illness.

These factors include whether people are wealthy or poor, employed or not, working conditions, access to quality education, health and social services, and the basics of food and affordable housing. These social determinants “are crucial factors in the health and well-being of Canadians,” he says.

“Contrary to the assumption that we have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us in the normal course of everyday life.”

Left: Dennis Raphael

That’s in large part because of the policies, regulations and laws enacted by governments at all levels, which influence employment income, family benefits and social assistance, as well as the quality and availability of affordable housing, health and social services, and recreational opportunities. That includes “what happens when Canadians lose their jobs during economic downturns such as the one that Canada began experiencing in 2008,” says Raphael.

“Governments also determine whether our children have access to affordable and high-quality child care and better-quality schools, the working conditions that we experience, and whether as seniors we receive levels of public pensions that allow us to live in dignity.”

Raphael wants to see changes in public policy that will affect Canadians’ health in a positive way. Through About Canada: Health and Illness, he wants the average Canadian to understand the role social determinants play in shaping health and what can be done to improve the situation through better public policies.

Raphael is the editor of , co-editor of and author of . He served as an adviser to the California Newsreel documentary series and the Deveaux Babin Productions Canadian documentary .

By Sandra McLean, YFile writer

Republished courtesy of YFile – 91��ɫ’s daily e-bulletin.

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