AACVPR In the News

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American Heart Association/American Stroke Association Stroke Champion Award – Michael McNamara, MS, FAACVPR


The Stroke Champion Award is reserved to recognize an individual’s outstanding contribution to stroke education and/or the system of care in their community. These efforts should enhance the American Heart/American Stroke Association’s image as a highly credible organization that positively impacts the public by expanding their understanding and knowledge on the signs and symptoms of stroke and stroke systems of care.  

Michael has had a substantial impact on stroke care in Montana over the last 8 years.  He works for the Montana Department of Public Health and Human Services and coordinates the Montana Telestroke Project.  The telestroke project connects stroke specialists residing in Washington, Oregon, Colorado and Montana to rural emergency departments via a 2-way audio/video link.  This allows patients in rural areas to be evaluated in real time by stroke neurologists who can then make time dependent treatment recommendations.  Since the inception of the project over 50 consultations have occurred and t-PA treatment rates are >20% which far exceeds the national average.  He was also involved in recently approved Legislation in Montana that require private insurance companies to reimburse for telemedicine consultations.  Michael also developed the Stroke Recognition Project where critical access hospitals who meet specific criteria are recognized for their commitment to treating acute stroke.  

Michael received his award at the American Heart Association/American Stroke Association Western States Affiliate awards banquet in Los Angeles on June 12th.


AACVPR Outpatient Cardiac Rehabilitation Registry Reaches 1,800 Patient Records

CHICAGO (October 11, 2012) – Since AACVPR officially launched its Outpatient Cardiac Rehabilitation Registry in June, 250 users from 160 programs have entered more than 1,800 patient records into the data system. Another 100 programs have subscribed and are expected to start entering patient data in the next several months. The United States’ first nationwide registry of its kind, the AACVPR Outpatient Cardiac Rehabilitation Registry is an unparalleled opportunity to demonstrate the positive impact of cardiac rehabilitation on the morbidity, mortality, physical function, and quality of life of heart patients.

“We are encouraged by the enthusiasm for this registry we have seen from cardiac rehabilitation programs nationwide,” said Mark Vitcenda, Chair of the AACVPR Registry Committee. “The Cardiac Rehabilitation Registry will be a powerful tool for tracking patient outcomes and program performance in secondary prevention of heart and vascular disease, and it will provide these programs with reliable national outcomes data for benchmarking.”

The Web-based registry allows subscribing cardiac rehabilitation programs to securely enter data on patient demographics; medical history; referral, enrollment and completion dates; healthcare utilization; and clinical, behavioral, and psychosocial measures at intake, discharge, and follow-up. Each subscribing program can pull customized reports of its patient and program data, as well as reports that show how its clinical, behavioral, health, and service outcomes compare to aggregated data from other programs based on region, program size, or other factors.

Under development since 2007, the Cardiac Rehabilitation Registry officially launched this past June. The data set was carefully developed by the cardiac rehabilitation experts on the AACVPR Registry Committee, and the registry went through three months of beta testing by a select number of cardiac rehabilitation programs. The registry platform was developed by Cissec Corporation, a Canadian-based software development firm specializing in healthcare technology, and will be overseen by the AACVPR Registry Committee.

Life Systems International (LSI) Inc. is providing unrestricted support of the registry as a founding sponsor. Additional unrestricted support is provided by Cardiac Science Corporation, Janssen Healthcare Innovation, the Rocky Mountain Cardiopulmonary Rehabilitation Association, and ScottCare Cardiovascular Solutions. AACVPR is also working with its corporate partners to provide connectivity applications to the registry to simplify data entry processes and help ensure data integrity.

To learn more about the registry, please visit www.aacvpr.org/CRregistry.

About AACVPR

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) is a multidisciplinary professional association of health professionals who serve in the field of cardiac and pulmonary rehabilitation. Its membership includes cardiovascular and pulmonary physicians and nurses, exercise physiologists, physical therapists, behavioral scientists, respiratory therapists, dietitians, and nutritionists. Founded in 1985, the nonprofit association is dedicated to reducing morbidity, mortality, and disability from cardiovascular and pulmonary disease and improving the quality of life for patients and their families.

Contact:

Ashley Anderson
312/673-5804
aanderson@aacvpr.org

###


Adherence Behavior in the Prevention and Treatment of Cardiovascular Disease

Abstract

Adherence is critical to the overall management of individuals at risk for and with cardiovascular disease. It forms an interplay between the patient, provider, and health care system and includes barriers that have been encountered within all 3 domains. Improving adherence to exercise, diet, and medication as well as focusing on addictive disorders such as smoking cessation requires patient, provider, and health care system approaches. The use of the cognitive/behavioral elements of health behavior change and communication strategies such as motivational interviewing and coaching serve to enhance overall adherence. Continuous quality improvement initiatives at the system level of change also increase the likelihood that teams will succeed in helping individuals change their behavior. Cardiac rehabilitation programs offer a unique opportunity for health care professionals to play a key role in supporting individuals through the health behavior change process.

Summary

Barriers to the adoption of healthy behaviors exist at the level of patients, providers, and the health care system as a whole. Patient adoption of health-enhancing behaviors can be fostered in cardiopulmonary rehabilitation programs and other settings by the use of communication techniques such as motivational interviewing and coaching. The elements of health behavior change offered by psychologists and health behavioral scientists can be tailored to specific behaviors. Multicomponent strategies have been shown to enhance long-term adherence. Finally, the CQI process helps to assure that changes at the patient, provider, and system level are sustained over time.

 

Click Here to read the full article in the Journal of Cardiopulmonary Rehabilitation & Prevention (JCRP).

 


2012 SCAN Excellence in Practice Award Recognizes Alisa Krizan, MS, RD, LD

May 2012 - Sports, Cardiovascular and Wellness Nutrition (SCAN), a dietetic practice group of the Academy of Nutrition and Dietetics, announced the recipients of their 2012 Excellence in Practice Awards. Established in 1996, this award recognizes the outstanding practice of SCAN members in one of the four SCAN practice areas: cardiovascular dietetics, wellness/health promotion, the prevention and treatment of disordered eating or sports dietetics. Members may receive the award for efforts as individuals, as part of a group, or as part of an organization. Areas of practice may include: clinical practice, public health practice, consulting/corporate health practice, program development, research, publication, education or volunteer practice.

As a long-standing advocate for nutrition and cardiovascular health, Alisa Krizan championed a formal networking agreement between SCAN and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), maintaining the role of liaison and contributing through service on the AACVPR Nutrition Scientific Advisory Committee, Annual Meeting Planning Committee for Nutrition, and writing for its News and Views publication.

Alisa’s distinguished career at the Mayo Clinic began as a clinical cardiac dietitian where she chaired the multidisciplinary Cardiology Continuous Improvement Committee, created the national award-winning video Eating for a Healthy Heart, and co-authored a study on interindividual variations in posture allocation, which was published in the journal Science. Currently, as Patient Food Service Manager, Alisa oversees the production and service of 2,000 meals per day at Mayo Clinic’s St. Mary’s and Rochester Methodist Hospitals, where her introduction of new and appetizing heart healthy menu items has resulted in improved patient satisfaction. A graduate of the University of Wisconsin-Stout and the Finch University of Health Sciences/Chicago Medial School, Alisa is also actively involved with the American Heart Association, bringing her positive attitude and passion for nutrition and cardiovascular health to community-based organizations and the individuals they serve.


Cardiologists Urged to Lead in Smoking Cessation

By Peggy Peck, Executive Editor, MedPage Today
Published: May 05, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


DUBLIN -- Cardiologists as a group have largely ignored tobacco as a modifiable risk factor, concentrating instead on hypertension and dyslipidemia, a pattern Ottawa cardiologist Andrew Pipe, MD, calls "substandard care."

Pipe is one of the moving forces behind the "Ottawa Model for Smoking Cessation," a cardiac-based program that boasts a "35% to 50% absolute cessation rate" and "over 450 bed-days saved at the University of Ottawa Heart Institute in 2009 with a $200,000 investment (ROI=355%)."

Ian Graham, MD, of Trinity College in Dublin, called the Ottawa program a blueprint for success and thus far unequaled.

Graham co-chaired the program committee at the EuroPRevent meeting where Pipe described his program.

A key to its success, Pipe said, was the buy-in from cardiologists, who previously gave only passing recognition to smoking.

When a patient with hypertension or hypercholesterolemia came to the emergency department it would "set off alarms and lights" and galvanize staff into action, but when a smoker was admitted, the cardiologist would usually wag a finger at the patient and remind him or her of the need to stop smoking.

"Meanwhile, every year we admitted 2,000 smokers upstairs," Pipe said in describing the "ah-ha" moment that led to the Ottawa Model.

But even as he recognized the need for action, he said that many colleagues said that an admission for STEMI or other acute event was "not the time to address smoking cessation, too stressful."

Pipe counters that the hospital is the ideal place to initiate smoking cessation for several key reasons:

  • There are large numbers of smokers admitted to the hospital, and smoking is a relevant factor in those admissions.
  • A heart attack can provide a potent motivation to quit.
  • Hospitals have available staff to work with the smoker, and the variety of staff makes the hospital an ideal incubator for a systemic approach to smoking cessation.
  • Pharmacotherapy for both withdrawal and cessation is available in hospitals.
  • Treating cardiologists can arrange follow-up

Follow-up, Pipe said, needs to be at least 6 months, and in the Ottawa model it starts with a phone call. "A call that is delivered at a time that is convenient for the patient, in a voice and a language that are understandable for the patient," he said.

The initial call consists of carefully constructed questions that can be answered with a simple "Yes" or "No." Those answers are then color-coded: red suggesting a patient at high risk of relapse or one who has already relapsed, yellow signaling a patient who has significant problems with cessation.

Using the color-coded responses, a team of nurses follows up with the patients.

The goal of the program, Pipe said, is to get the patients to a point where they are comfortable without cigarettes and are no longer craving nicotine -- a tough goal since most patients will have several relapses.

But Pipe said that multiple relapses should not be considered failure by either the patient or the physician because "every smoker who has successfully stopped smoking has a history of multiple failed attempts. Each attempt increases the likelihood of eventual success."

Pipe said he received research or education grants or served as a consultant to Pfizer, GSK, and Johnson & Johnson.

Primary source: EuroPRevent 2012
Source reference: Pipe, A "Smoking cessation: good news at last!" EuroPRevent 2012; Translational Science, Session 243.

Click Here to access the MedPage Today article online


Cardiac Rehab: Low Tech, Low Cost, Big Benefit

By Peggy Peck, Executive Editor, MedPage Today
Published: May 06, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

DUBLIN -- Emerging data show that, in patients who have post-MI rehabilitation, long-term survival may be boosted by as much at 59% compared with patients who are not prescribed rehabilitation.

But the benefit of cardiac rehabilitation is often never realized because utilization of rehab programs is low, according to Steven W. Lichtman, EdD, president of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and director of cardiopulmonary outpatient services at Helen Hayes Hospital in West Haverstraw, N.Y.

A 2007 study published in Circulation: Journal of the American Heart Association drove home that point, Lichtman explained in a presentation at EuroPRevent 2012.

"The study analyzed Medicare claims data from 267,427 patients hospitalized for MI and found that only 13.9% of those patients had cardiac rehabilitation," he said.

After coronary artery bypass grafting (CABG), the utilization rate was 31%, but it varied widely by region, from a low of 7% in Idaho to a high of 53% in Nebraska.

Lichtman said that was a wake-up call for the AACVPR, which responded by organizing support for implementation of performance measures and national quality guidelines for cardiac rehabilitation.

That same year -- 2007 -- the association enlisted the American College of Cardiology and the American Heart Association as co-sponsors of performance measures for cardiac rehabilitation and secondary prevention services.

Early initiation of a rehabilitation program is essential for achieving maximum benefit, Lichtman said, so the performance measures stipulate that patients hospitalized for a qualifying event should be referred to early outpatient cardiac rehab prior to discharge.

Qualifying events -- those for which Medicare has approved payment for rehabilitation -- include MI, chronic stable angina, CABG, percutaneous coronary interventions, valve surgery, and heart transplantation.

An analysis of crude 5-year data from 601,099 acute coronary syndrome patients, published by the Journal of the American College of Cardiology in 2009, revealed a 59% relative risk reduction in mortality for patients who had cardiac rehabilitation.

In 70,040 propensity-based matched pairs, the mortality rate at 5 years was 16.3% in cardiac rehabilitation patients versus 24.6% among those who did not have rehab, for a relative risk reduction of 34%.

Additionally, cardiac rehabilitation programs "are a low-cost, low-tech solution that per dollar spent is more effective than bypass surgery," Lichtman said.

Currently, he said, "cardiac rehabilitation is reimbursed at an average of $65 per session, but it is valued at $100 a session."

Lichtman said he had no financial conflicts.

Primary source: European Association for Cardiovascular Prevention & Rehabilitation

Source reference: Lichtman, SW "Implementation of performance measures and national quality guidelines for cardiac rehabilitation in the United States" EuroPRevent 2012; Presentation 200.

Click Here to access the MedPage Today article online.


AACVPR & LSI on Discovery Channel


Click play button to watch video on YouTube (will open in new window).

AACVPR and Life Systems International (LSI) recently collaborated on a Discovery Channel Profile Series production regarding women’s health issues.

This project helps promote AACVPR and define Cardiac Rehabilitation and its benefits to a national audience including patients, clinicians, hospital administrators, cardiologists, and the general public. The under utilization and under appreciation of cardiac rehabilitation is highlighted, along with scientific evidence documenting the morbidity and mortality benefits of participation.  Additionally, the need for increased physician referral to cardiac rehab, along with the incorporation of the performance measure sets and guidelines, is also discussed.

The program aired on Discovery Channel on Wednesday May 2, 2012. The series is hosted by Lou Gossett, Jr. and covers a broad range of topics including Environmental, Education, Medical, and Health related content.

This is a great opportunity for your program to gain exposure and gather local support for your rehab program. Inviting referring physicians, cardiologists, and hospital administrators to view this documentary will help raise awareness for your program and the positive clinical outcomes you achieve with your patients every day. 

The timing of this program could not be better with the National Cardiac Rehabilitation Registry scheduled to launch in June 2012. Please support this effort by watching the program and encouraging others within your patient care contingency to join you. 

Click Here to view the video on YouTube.

LSI has supported AACVPR’s involvement in the program and continues to independently support and advocate for the cardiac and pulmonary rehabilitation industry. LSI is an independent industry participant that offers telemetry monitoring systems and consulting services. LSI is not a partner or affiliate with AACVPR. 


Cardiac rehabilitation programs help participants resume a healthy lifestyle after cardiac event

Cardiac rehabilitation programs help participants resume a healthy lifestyle after a cardiac event, such as a heart attack, open heart surgery, or angioplasty and stenting. Often referred to as “cardiac rehab,” these programs include monitored exercise, education and counseling about cardiac risk factors, and psychosocial support. Studies have shown that participants who complete cardiac rehab programs have better odds of a longer life than those who don’t complete a program.

Who Is Eligible for Cardiac Rehabilitation?

Cardiac rehabilitation programs are appropriate for patients who have had a heart attack, angioplasty or stent, open heart surgery such as coronary artery bypass, valve replacement, or heart transplant, or for people with a diagnosis of angina or heart failure. Insurance coverage for these diagnoses may vary.

There is no minimum or maximum age limit for participation, and cardiac rehab is effective for both men and women. Cardiac rehabilitation professionals have been specially trained in how to individualize exercise programs, based on your age, level of fitness, other medical conditions, and previous experience with exercise equipment. In fact, cardiac rehabilitation staff design personalized education and counseling sessions according to a participant’s unique assessment and needs.

Recent studies have shown that people who attend cardiac rehabilitation are more likely to be alive and well 5 years after their heart event than those who do not.

Cardiac rehabilitation also improves:

  • Exercise capacity and stamina
  • Quality of life
  • Sense of well-being
  • Adherence to healthy lifestyle changes and medications

What to Expect in Cardiac Rehabilitation

Benefits from exercise are greatest when a person exercises 3 to 6 times per week, so most cardiac rehabilitation programs expect participants to attend 2 or 3 exercise sessions per week at the cardiac rehabilitation center and to supplement this with exercise at home, such as walking. Cardiac rehabilitation professionals develop an individualized exercise prescription for participants, based on information from the referring doctor. Sessions generally last around an hour and may also include education about nutrition, stress reduction, medications, smoking cessation, and exercise. After completing supervised monitored exercise for 24 to 36 sessions, participants are encouraged to continue with regular exercise, either at home or in their community. Many cardiac rehabilitation programs offer wellness or maintenance exercise programs for people with heart disease to continue to exercise in supervised group sessions. These programs are generally low cost and are paid for by the individual.
How Can You Find a Cardiac Rehabilitation Program?

To find a program in your area, visit the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Program Directory.

To learn more about cardiac rehab and help as you discuss cardiac rehab with your healthcare provider, please print by clicking on the image or email it and share this one-page resource sheet developed by AACVPR.

Source: The Society for Cardiovascular Angiography and Interventions

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