Published in the current issue of the , the study reports that despite guidelines encouraging physicians to recommend heart failure clinics, few patients recently hospitalized with heart failure receive referrals or use one.

“Given the demonstrated benefits of these services, the rates of referral and enrollment in our study are discouragingly low,” says lead investigator Shannon Gravely (PhD ’11) of 91��ɫ, the University Health Network and the Toronto Rehabilitation Institute. 91��ɫ Professor Sherry Grace and Professor Liane Ginsburg both of 91��ɫ’s Faculty of Health were also involved with the study.

Shannon Gravely

The investigators recruited 474 heart failure inpatients from 11 hospitals across Ontario. The patients completed a survey that evaluated environmental and individual factors affecting heart failure clinic use. Environmental factors included hospital type, whether the hospital had an onsite heart failure clinic and whether the patient had been referred to other outpatient disease management programs (DMP), such as smoking cessation clinics or diabetes education. Individual factors included socio-demographic information, whether the patient lived in a rural area, marital status, perceived stress and depressive symptoms. Clinical indicators of the need for rehabilitative services were gathered from patient charts.

A year after the first survey, the patients received a second survey. The 270 patients who completed the follow-up survey reported on whether they had been referred to a heart failure clinic and if they had attended.

Results showed that 15 per cent of study participants were referred to a heart failure clinic and 13 per cent reported using one. Patients with higher education were five times more likely to use an outpatient heart failure clinic compared to those with lower education. Lower stress levels and more serious health conditions were also associated with heart failure clinic use. Patients who received a referral to another DMP were nearly five times more likely to use a heart failure clinic. The most important factor in determining whether a patient used a heart failure clinic was the presence of an established program at the patient’s original hospital.

“It’s likely that having an HR clinic on-site is related to greater awareness of the benefits of such services by physicians providing care,” says Gravely. “However, broader referral mechanisms are needed to ensure that all patients, regardless of where they receive care, have equitable access to heart failure clinics.”

In a related study published in the same issue, Gravely and colleagues examined more broadly the use of DMPs by patients with cardiovascular disease (CVD). The survey looked at factors that influenced DMP use and was completed by 1,803 hospitalized patients, along with a follow-up study a year later which assessed whether they had used any DMPs, such as cardiac rehabilitation, outpatient diabetes education, a heart failure clinic, stroke rehabilitation or a smoking cessation program.

Overall, roughly 40 per cent of patients did not access any post-acute DMPs, 50 per cent accessed one program and 10 per cent attended more than one. Among participants with a comorbid indication (diabetes, stroke, heart failure or smokers), 21 per cent of these participants reported that they used multiple programs. DMP participants were younger, more likely to be married and more highly educated than those who did not attend DMPs.

Overall, 53 per cent reported participating in cardiac rehabilitation, and among participants with a comorbid illness or risk, 41per cent of diabetics reported attending a diabetes education center, 26 per cent of stroke patients attended stroke rehabilitation, 13 per cent of patients with a heart failure diagnosis used a heart failure clinic and 12 per cent of smokers attended a smoking cessation program. Among all study participants these findings suggest a gross underuse of DMP services, particularly stroke rehabilitation, heart failure clinics, and most notably, smoking cessation programs.

“What is one of the most concerning findings is that only 12 per cent of current smokers reported taking part in a smoking cessation program,” says Gravely. “Participation in smoking cessation programs results in significantly higher cessation rates when compared with standard care.”

Gravely notes that future research is needed to explore not only patient-related factors, but also health-system factors, such as awareness and capacity that may be at play. “The appropriateness and cost repercussions of multiple DMP use should be investigated, as an integrated approach to vascular disease management may be warranted.”

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

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The letter was delivered to Zoidl by 91��ɫ Vice-President Research & Innovation, Robert Haché, Faculty of Health Dean Harvey Skinner and Faculty of Science & Engineering Dean Janusz Kozinski.

Above: from left, Faculty of Health Dean Harvey Skinner; VP Research & Innovation Robert Haché; Professor and CRC Georg Zoidl; and Faculty of Science & Engineering Dean Janusz Kozinski

“On behalf of the 91��ɫ research community, I am delighted that Dr. Georg Zoidl’s research and appointment as Canada Research Chair in Mollecular and Cellular Neuroscience has been acknowledged by Canada’s Prime Minister through this correspondence,” said Haché.  “Professor Zoidl is a highly accomplished, world-class researcher who we look to for leadership in the development of this exciting area of research and 91��ɫ's broader research agenda.”

Zoidl’s research examines the functions of nerve cells in the brain and the visual system as a means to understanding overall brain activity in health and disease. The research explores the communication processes in the brain that contribute to disease-causing conditions. Even small changes in communication between these nerve cells might get amplified over a lifetime and will be at the heart of a wide spectrum of diseases.

He is addressing the role of electrical communication in the visual system and the brain using genetically-altered zebra fish; their brains and eyes utilize the basic communication principles found in humans. His research combines high-end imaging tools with careful molecular and cellular manipulations to track how information flows into the brain and eye under healthy and diseased conditions. The research will foster insight into the molecular and cellular basis of epilepsy and could ultimately lead to improved treatment for vision loss.

“I am honored to receive this letter from Canada’s Prime Minister, which recognizes the importance of my research,” said Zoidl. “In Canada, securing and preserving quality of life is highly dependent on an individual’s prolonged and sustained quality of health. With vision loss listed in the top 10 most costly disease groups and approximately 15,500 new epilepsy patients each year, it is important to study the fundamental communication processes in the nervous system from molecules to systems in order to develop preventative health measures.”

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

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Sherry Grace

Grace returned yesterday from the World Congress of Cardiology, held in Dubai, where she presented an . The document, created by scientists from several universities and cardiac rehabilitation associations, is endorsed by 10 cardiovascular organizations in high-income countries such as Canada, the United States and Britain, as well as middle-income countries such as India.

Cardiac rehabilitation is an outpatient chronic disease management program to which patients should be referred after a cardiac event or procedure. Each patient is assessed and managed by clinical staff, undergoes an exercise test and follows a four-to-six-month program of exercise, nutrition counselling and health education. While bypass surgery may cost $40,000 to $80,000, the cardiac rehab that should follow it costs only $1,500.

“The benefits of cardiac rehab are well established. There are over 11,000 patients tested in 40 trials performed around the world. The data shows 25 per cent lower death for patients who go to rehab versus those who don’t, as well as significant reductions in re-hospitalization,” says Grace.

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“The magnitude of the benefit is similar to what patients see with aspirin and statins. Doctors always recommend those but they don’t always recommend cardiac rehab and that’s a shame,” adds Grace.

Cardiovascular disease remains the leading killer of adult men and women globally, so cardiac rehab programs could extend and improve millions of lives, says Grace. A professor of kinesiology and health science at 91��ɫ, Grace is also director of research into cardiovascular rehabilitation and prevention at the Peter Munk Cardiac Centre, University Health Network.

On average, about 30 per cent of Canadian patients are referred for cardiac rehab after a heart attack or surgery. Grace has developed strategies in the past few years to increase the number of Canadian heart patients being referred to cardiac rehab programs – as a result, in some hospitals in Ontario, the rate is as high as 85 per cent. In contrast, only about 20 per cent of middle- and low-income countries around the world have any sort of cardiac rehab at all, and only the elite can afford it, says Grace.

“We really do need to do more to promote the availability of cardiac rehab in these countries, considering that many middle-income countries now have full operating theatres to perform revascularization procedures,” says Grace. “If we can provide that acute care, which is quite expensive, certainly we can provide the low-cost care provided by cardiac rehab with similar benefits.”

The International Charter on Cardiovascular Prevention and Rehabilitation and the international effort to gain support for its call for action was funded through a knowledge-mobilization grant from the Canadian Institutes of Health Research.

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

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