Archived AACVPR In the News

September 2011: Phycisian and Leaders Supporting Vascular Health Deservedly Recognized
September 2011: September is PAD Awareness Month: Are you Aware?
Updated ACCF/AHA/AACVPR Performance Measures Aim to Increase Patient Referral to Cardiac Rehabilitation Programs, Improve Quality of Care following Cardiac Events
New Exercise Toolkit Provides a Guide for Peripheral Arterial Disease Professionals
Predictors of Cardiac Rehabilitation Referral
AACVPR Affirms Cardiac Rehabilitation Prolongs Life in Medicare Population
Study Shows Drastic Improvement Following Pulmonary Rehabilitation: Full Article Published in CHEST


 

Physicians and Leaders Supporting Vascular Health Deservedly Recognized:

2011 Vascular Disease Foundation Award Winners Announced at Annual Meeting

WASHINGTON (Sept. 23, 2011) – The Vascular Disease Foundation (VDF) presented its annual awards at the organization’s eighth annual meeting in Washington. The awards honor the work of citizens, health care providers, organizations, researchers and companies that have enhanced the understanding and/or treatment of peripheral vascular diseases. The most prestigious award, the Julius H. Jacobson II MD Award for Physician Excellence, recognizes outstanding contributions to physician education, leadership and patient care in vascular dieases.

This year’s recipient is Barry T. Katzen, MD, medical director of Baptist Cardiac & Vascular Institute in Miami and professor of radiology at the University of Miami.

Dr. Katzen has done much to advance the cause of endovascular interventions including pioneering many of the methods of percutaneous transluminal angioplasty and was one of the first to popularize fibrinolytic therapy. His most unique contribution to education was pioneering the use of “live-case” tutorial for vascular education which has evolved into a teaching tool for procedure-oriented specialties.

In addition to the Jacobson award, the VDF presented its President’s Awards which recognize individuals who have assisted the foundation in accomplishing its mission to improve health for all by reducing death and disability from vascular diseases.

“The President’s Awards for Vision, Leadership, Inspiration and Partnership show our appreciation for the extraordinary initiatives to support the foundation’s efforts to increase awareness of vascular disease and enhance patient lives,” said Robert McLafferty, MD, president of the VDF.

This year’s President’s Awards were presented as follows:

President’s Award for Inspiration was given to Beth Murray, MS, NP the HeartCaring/Cardiac Outreach Coordinator at Brookhaven Memorial Hospital Medical Center in Patchogue, NY. To her patients, she is a lifeline of hope and inspiration, listening to their stories and helping them understand how to manage their vascular health issues.

President’s Award for Leadership was given to Anton N. Sidawy, MD, MPH, Professor and Chairman of the Department of Surgery at the George Washington University Medical Center in Washington, DC. Dr. Sidawy also serves as the Editor-in-Chief of the Journal of Vascular Surgery and he is a Past-President of the Society for Vascular Surgery. Having served on VDF’s Board of Directors since June 2003, Dr. Sidawy was VDF’s President-Elect and President from 2006 to 2010. Through his dedication to and leadership of VDF, he has shown his commitment to VDF's mission in increasing the awareness of vascular disease and improving vascular health.

President’s Award for Partnership was given to American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). For over a year the AACVPR had partnered with VDF to create, review and promote the PAD Exercise Toolkit and has cross-promoted the program to its members. Over 1,000 professionals have used the program over the past year.

President’s Award for Vision was given to the Center for Vascular Awareness in Albany, N.Y. and Dr. Manish Mehta, vascular surgeon and endovascular specialist, for their advancement of vascular awareness through quarterly meetings held for health care providers and others in the community.

“It gives me great honor to present these awards on behalf of VDF,” said McLafferty. “This year’s recipients have made such an outstanding contribution to not only VDF but the field of vascular medicine. It is such a privilege to acknowledge those committed to advancing the field of vascular disease.”
About The Vascular Disease Foundation

The Colorado-based Vascular Disease Foundation is the only national non-profit organization with the sole purpose of educating the public about vascular diseases. It is the most trusted source of credible, scientific and non-biased information on vascular diseases. For more information, call (888) VDF-4INFO or (888) 833-4463 or visit our Web site at www.vdf.org.

AACVPR Past President and Professional Liaison Committee Chair Marjorie King, MD, MAACVPR, accepts the 2011 VDF President’s Partnership Award on behalf of AACVPR.

 


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Contact:
Christa Saracco, Communications Manager
Vascular Disease Foundation
1075 S. Yukon Street, Suite 320
Lakewood, CO 80226
Phone: (303) 989.0500
Toll-free (888) VDF-4INFO or (888) 833-4463
Email: christa.saracco@vdf.org


September is P.A.D. Awareness Month: Are you Aware?

Free Online Resources Provide Peripheral Arterial Disease Education and Support

DENVER (Sept. 21, 2011) — Affecting approximately 9 million Americans, peripheral arterial disease (P.A.D.) can lead to heart attack, stroke, amputation and death. That’s why the Peripheral Arterial Disease (P.A.D.) Coalition wants you to learn about P.A.D. during September’s awareness month.

In support of P.A.D. Awareness Month, the P.A.D. Coalition is providing a free online interactive workbook that works like an online booklet, with turning pages, narrated text, videos, graphics, printable handouts and quizzes. It covers risk factors, symptoms and diagnosis and the key components of disease management. To access the workbook and many additional patient and provider resources, visit http://www.padcoalition.org/resources/interactive-workbook.php.

P.A.D. occurs when arteries in the legs become narrowed or clogged with fatty deposits, reducing blood flow to the legs. This can result in leg muscle pain when walking, disability, amputation, and poor quality of life. Blocked arteries found in people with P.A.D. can be a red flag that other arteries, including those in the heart and brain, may also be blocked – increasing the risk of a heart attack or stroke.

While everyone over the age of 50 is at risk for P.A.D., the risk increases if a person:

  • Smokes, or used to smoke
  • Has diabetes
  • Has high blood pressure
  • Has abnormal blood cholesterol
  • Is African American
  • Has a personal history of coronary heart disease or stroke

A devastating disease that is often undiagnosed, many with the disease do not even know they have it. That’s because often P.A.D. causes no recognizable symptoms. However, some people with P.A.D. may have one or more symptoms such as fatigue, heaviness, tiredness or cramping in the leg muscles (calf, thigh or buttocks) that occurs during activity such as walking and goes away with rest; foot or toe pain at rest that often disturbs sleep; skin wounds or ulcers on the feet or toes that are slow to heal.

National medical guidelines recommend that certain individuals be tested for P.A.D. including those that have one or more of the following:

  • Under 50 years of age but have diabetes and at least one other risk factor including a history of smoking, abnormal cholesterol and/or high blood pressure
  • Aged 50 years or older and have diabetes
  • Aged 50 years or older and is a former or current smoker
  • Aged 70 years or older.
  • One or more symptoms of P.A.D.
  • Fatigue, heaviness, tiredness or cramping in the leg muscles (calf, thigh or buttocks) that occurs during activity such as walking and goes away with rest.
  • Foot or toe pain at rest that often disturbs sleep
  • Skin wounds or ulcers on the feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks).

The screening test for P.A.D. is called the ankle-brachial index, a painless, non-invasive test that compares the blood pressure in the ankles with the blood pressure in the arms. This test can be done in most doctors’ offices. Information on the test and how to manage P.A.D. are detailed in the online workbook (http://www.padcoalition.org/resources/interactive-workbook.php).

 For more information on P.A.D. Awareness Month, screening resources and sites, patient education, and the P.A.D. Coalition, please visit http://www.padcoalition.org/resources/month.php. To receive a free “Heart and Sole Kit” with more information on P.A.D. please visit http://www.padcoalition.org or call 1-866-PAD-INFO (866-723-4636). 

About the P.A.D. Coalition

The Peripheral Arterial Disease (P.A.D.) Coalition is an alliance of more than 80 North American health organizations, professional societies, government agencies and corporations united to improve the health and care of patients with P.A.D. Established in 2004, the P.A.D. Coalition is an initiative of the Vascular Disease Foundation (www.vdf.org), a national, not-for-profit section 501(c)(3) organization. It is supported in part by the following national sponsors: the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; Cordis Endovascular, a division of Cordis Corporation; Abbott Vascular; AstraZeneca; Bard Peripheral Vascular; BioMedix; Cook Medical, Inc;, ev3 Endovascular, Inc.; W.L. Gore & Associates; Medtronic, Aastrom; PADTest; Summit Doppler and Unetixs/Cardiac Science. The P.A.D. Coalition seeks to improve the prevention, early detection, treatment, and rehabilitation of people with, or at risk for, PAD. To learn more visit www.padcoalition.org.

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Contact:
Christa Saracco, Communications Manager
Vascular Disease Foundation
1075 S. Yukon Street, Suite 320
Lakewood, CO 80226
Phone: (303) 989.0500
Toll-free (888) VDF-4INFO or (888) 833-4463
Email: christa.saracco@vdf.org


 

Updated ACCF/AHA/AACVPR Performance Measures Aim to Increase Patient Referral to Cardiac Rehabilitation Programs, Improve Quality of Care following Cardiac Events

Despite lifesaving benefits, only one in five patients receives cardiac rehabilitation

(August 30, 2010) –  Cardiac rehabilitation – an organized, medically supervised program of services that might include exercise training, nutritional counseling and group support, among others – can significantly improve the life expectancy and quality of life of people who have had a recent cardiac event, such as a heart attack, angioplasty or heart surgery. Yet, only one in five eligible patients actually receives this lifesaving and life-improving therapy.

To increase the appropriate and timely referral of these patients to outpatient cardiac rehabilitation programs, the American College of Cardiology Foundation (ACCF), the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and the American Heart Association (AHA) today issued updated performance measures. These measures are intended to help hospitals, doctors and other health care providers more easily track referral rates, adopt tools to improve enrollment (e.g., automatic ordering sets), and assess and improve the quality of care provided.

“The gap in referral of patients to cardiac rehabilitation represents the largest gap in care for patients following a cardiac event,” said Randal J. Thomas, M.D., M.S., director of the Cardiovascular Health Clinic at the Mayo Clinic in Rochester, Minnesota, president of the AACVPR and chair of the writing committee. “The updated measures will hopefully help to improve the health of patients with heart disease by increasing the number of eligible patients who are referred to and receive the lifesaving benefits of cardiac rehabilitation.”

According to previous reports, enrollment in cardiac rehabilitation programs has been shown to reduce the likelihood of dying (from all causes) by up to 30 percent.

“These programs can also help prevent future heart-related problems and are generally covered by most health insurance providers,” adds Dr. Thomas. “In addition, other co-existing conditions, such as diabetes, high blood pressure, sleep apnea and depression are identified and managed to make sure that all related aspects of the patient’s heart care are covered and coordinated.”

The underuse of cardiac rehabilitation services is due, in part, to the lack of physician referral either because providers forget to refer patients, are not aware of cardiac rehabilitation services in their area or may not understand the significant benefits to patients. Moreover, patients may lack health insurance coverage and perhaps cannot easily travel to a nearby program, especially if they live in rural areas or in places without good public transportation.

The updated ACCF/AHA/AACVPR performance measures paper reinforces the national focus on health care quality and accountability. But efforts are needed to ensure these measures are translated to clinical practice.

“We must encourage all hospitals and practices caring for patients with heart disease to begin measuring their referral rates to cardiac rehabilitation and then change their care processes to improve those rates,” said Dr. Thomas.
Patients usually participate in cardiac rehabilitation programs for three to six months, and may receive long-term follow up.

This update is also endorsed by other national health care organizations including the American College of Chest Physicians, the American College of Sports Medicine, the American Physical Therapy Association, the Canadian Association of Cardiac Rehabilitation, the Clinical Exercise Physiology Association, the European Association for Cardiovascular Prevention and Rehabilitation, the Inter-American Heart Foundation, the National Association of Clinical Nurse Specialists, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.

Full text of this report will be published in the September 28, 2010, issues of the Journal of the American College of Cardiology, and Circulation: Journal of the American Heart Association and the September/October 2010 issue of the Journal of Cardiopulmonary Rehabilitation and Prevention. It will also be available on the ACC (www.cardiosource.org), AHA (www.americanheart.org) and ACCVPR (www.aacvpr.org) Web sites.

Dr. Thomas reports no conflicts of interest.

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New Exercise Toolkit Provides a Guide for Peripheral Arterial Disease Professionals

LAKEWOOD, CO, (July 8, 2010) – The Vascular Disease Foundation (VDF) announced the launch of its new “Peripheral Arterial Disease (PAD) Exercise Training Toolkit: A Guide for Health Care Professionals.” This toolkit was developed jointly by the Vascular Disease Foundation (VDF) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).

This valuable new resource is now available to help health professionals develop supervised exercise programs for patients with intermittent claudication (leg discomfort from poor blood supply). Clinical practice guidelines for adults with PAD stress the importance of supervised exercise to improve functional capacity, decrease symptoms and achieve systemic risk-reduction benefits.

According to Dr. Marjorie King, chair of the toolkit writing group, a board member of VDF and a past president of AACVPR, “Most physicians recognize the importance of regular supervised exercise to improve symptoms of lower extremity claudication, but they may not be aware that cardiac rehabilitation, medical fitness, and wellness programs in their community can provide these services. The toolkit was developed so that a physician’s recommendation of “get out and walk” can be accompanied by a referral to a program that follows evidence-based principles and protocols.”

The toolkit includes information for exercise and rehabilitation professionals to implement appropriate and safe supervised exercise programs. It also includes practical tools such as sample brochures plus participant and staff education materials.

While the toolkit is available for free, users are asked to create a user name and password so they may receive updates to guidelines as they become available. The toolkit will also be featured during a workshop, Implementation of the AACVPR/VDF PAD Toolkit: Improving and Expanding Your Patient Services, on October 6, 2010, prior to the AACVPR 25th Annual Meeting in Milwaukee. For more information on this workshop, visit www.aacvpr.org\annualmeeting.

About AACVPR
Founded in 1985, the American Association of Cardiovascular and Pulmonary Rehabilitation is a multidisciplinary organization dedicated to the mission of reducing morbidity, mortality and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research and disease management. Central to the core mission is improvement in quality of life for patients and their families.

About VDF
The Vascular Disease Foundation is the only national organization with the sole purpose of educating the public about vascular diseases. It is the most trusted source of credible, scientific and non-biased information on vascular diseases. For more information, call 888/VDF-INFO (888/833-4463) or visit www.vdf.org

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Predictors of Cardiac Rehabilitation Referral

(August 25, 2009) -- Recently, a group led by Todd Brown, MD, MSPH, analyzed data from 72,817 patients discharged alive after a myocardial infarction (MI), percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery (CABG), between January 2000 and September 2007 from 156 hospitals participating in the AHA Get With the Guidelines Program.1 Overall, only 40,972 (56%) were referred to cardiac rehabilitation at discharge, ranging from 53% for MI, to 58% for PCI to 74% for CABG patients.  Analysis by institution revealed wide discrepancies:  35% of hospitals referred <20% of eligible patients, and only 22% of hospitals referred > 80%.  Older age, non-ST-segment elevation myocardial infarction, and the presence of most co-morbidities were associated with decreased odds of cardiac rehabilitation referral, despite the fact that the benefits of participation are proportionally greater in many of these patients.2

These results are especially problematic in light of the recent landmark study by the Brandeis group looking at more than 600,00 Medicare patients that showed that patients who enrolled in a cardiac rehabilitation program had substantially lower mortality than those who did not:  2.2% versus 5.3% at 1 year and 16.3% versus 24.6% at 5 years.3 There was a dose response relationship as well – patients who attended 25 or more sessions had approximately 20% lower 5 year mortality than those who attended 24 or less sessions.  Of note, this study used three sophisticated analytic techniques to control for diagnosis, co-morbidities, and demographics, and validated similar results from previous smaller studies and meta-analyses.

These studies are a call for action to healthcare professionals.  Participation in cardiac rehabilitation has similar mortality benefits as many of the other secondary prevention measures, yet many institutions continue to do poorly with this measure.  Healthcare providers and hospitals should feel confident that cardiac rehabilitation is a life saving intervention that should be provided to all of the appropriate patients whom they serve.  Barriers to referral should be eliminated, referral rates and enrollment monitored, and patients reassured that participation in cardiac rehabilitation will improve their quality and quantity of life.

References

  1. Brown TM, Hernandez AF, Bittner V et al.  Predictors of Cardiac Rehabilitation Referral in Coronary Artery Disease Patients:  Findings From the American Heart Association’s Get With The Guidelines Program.  J Am Coll Cardiol 2009;54:515-521
  2. Wenger NK. Current Status of Cardiac Rehabilitation. J Am Coll Cardiol 2008;51:1619-31
  3. Suaya JA, Stason WB, Ades PA et al. Cardiac Rehabilitation and Survival in Older Coronary Patients. J Am Coll Cardiol 2009;54:25-33

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AACVPR Affirms Cardiac Rehabilitation Prolongs Life in Medicare Population

CHICAGO (June 24, 2009)— A study published in the current issue of the Journal of the American College of Cardiology, shows new evidence that cardiac rehabilitation, an under-utilized service, increases survival in a wide range of patients with heart disease. Philip Ades, MD, a past president of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), participated in a Brandeis University-led study that provides new evidence supporting the benefits of cardiac rehabilitation in older patients with heart disease.

Researchers from Brandeis University (Jose Suaya, MD; William Stason, MD; Donald Shepard, MD), the University of Vermont (Philip Ades, MD), and Harvard University (Prof. Sharon Lise-Normand) conducted an analysis of 601,099 Medicare beneficiaries who were hospitalized in 1997 for coronary heart disease, acute myocardial infarction, angioplasty, stent or bypass surgery and followed up through 2002. Their findings demonstrated that cardiac rehabilitation participation after one of these cardiac events was associated with a significant 21-34% increase in five-year survival rates, similar to that found with the use of other preventive therapies including cholesterol-lowering medications and beta blockers. Mortality reductions also extended to those with congestive heart failure. Ironically, despite these significant benefits, only 12% of eligible patients actually used cardiac rehabilitation services.

“This study clearly shows that cardiac rehabilitation works,” said Ades. “And although it is a covered benefit under Medicare, we can see that cardiac rehab is still severely underused in this population.”

Drs. Suaya, Ades and the other co-authors further commented: “These effects on survival are so convincing that expanded use of cardiac rehabilitation is critical. Cardiac rehabilitation is a low-cost, low-tech intervention that not only raises survival rates but also improves functional capacity, thereby decreasing disability. We should consider implementing quality-of-care performance measures for hospitals and physicians to encourage referral and utilization of cardiac rehabilitation.”

This study was funded by the Centers for Medicare & Medicaid Services.

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Study Shows Drastic Improvement Following Pulmonary Rehabilitation: Full Article Published in CHEST

(February, 2009) --  Pulmonary Rehabilitation has long been shown to improve symptoms and function in persons with disorders such as chronic obstructive lung disease or COPD. A recent study published in the February 2009 issue of CHEST, the journal of the American College of Chest Physicians provides evidence that other disorders such as interstitial lung disease and pulmonary fibrosis may benefit from Pulmonary Rehabilitation. Interstitial lung disease and pulmonary fibrosis usually involve inflammation of lung tissue that leads to scaring and shortness of breath with exercise. Pulmonary Rehabilitation includes supervised exercise and education to improve function and independence and control of symptoms caused by chronic lung disease. The study included three US Pulmonary Rehabilitation programs at the following sites:  Seton Medical Center in Daly City, California, John Muir Medical Center in Concord, California and Inova Medical Center in Fairfax, Virginia. The study of 99 persons with interstitial lung disease showed significant improvement in shortness of breath and function measured by walk distance after Pulmonary Rehabilitation. The study is the largest trial to date to look at the effect of Pulmonary Rehabilitation in persons with interstitial lung disease. The timing of the study is particularly important given the long struggle to establish Medicare coverage for Pulmonary Rehabilitation. Beginning January 2010, persons with chronic lung disease will be eligible to attend Pulmonary Rehabilitation under Medicare coverage.

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