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(Please also see a PDF version of the following information)
Patient referrals to the Cardiac Fitness Institute will end March 2018. LHSC is committed to ensuring that all CFI patients referred until this date will receive six months of cardiac rehabilitation care.
In Ontario, patients who have suffered a serious cardiac event can be referred for up to 6 months of post-event therapy and counseling services through a model of rehabilitation care endorsed by CorHealth Ontario (formerly the Cardiac Care Network) and the Ministry of Health and Long-Term Care.
In London, these provincially-funded services are offered through the Cardiac Rehabilitation and Secondary Prevention (CRSP) program at St. Joseph’s Health Care London. The majority of post-acute cardiac patients in London and the region are already referred to the CRSP program at St. Joseph’s. These services do not fall under the mandate of acute care hospitals and LHSC receives no funding to support similar services and can no longer subsidize the costs of the CFI program.
Given these realities, and after consultation with St. Joseph’s Health Care London, CorHealth, and the Local Health Integration Network—which also advised the Ministry of Health and Long-Term Care—the decision has been made to wind down the Cardiac Fitness Institute. Effective March 2018, all post-acute cardiac patients will be referred to the CRSP.
Why are you closing the program?
As an acute care hospital, LHSC does not receive public funding to support post cardiac event therapy and counseling services for patients. In alignment with the provincial model, the Ministry of Health and Long-Term Care funds the Cardiac Rehabilitation and Secondary Prevention (CRSP) program at St. Joseph’s Health Care London to deliver these services.
The majority of post-acute cardiac patients are already referred by cardiology to the St. Joseph’s program and there is excellent collaboration between the LHSC and St. Joseph’s teams to ensure seamless transitions for these patients. With this proven model well established and already supporting the majority of cardiac patients requiring such services, and the absence of sustainable funding for the Cardiac Fitness Institute at LHSC, the decision has been made to wind down the Cardiac Fitness Institute (CFI).
How many patients are affected by the closure?
The most recent data indicates less than 10 patients per month are referred to the CFI. There are about 100 patients who have continued to utilize the exercise facilities at CFI on an ongoing basis. No other cardiac program in Ontario provides an ongoing fitness service.
What happens to patients that have been using the ongoing fitness service?
CFI patients who have previously concluded their 6-month cardiac rehab program are encouraged to continue their exercise program within the community and CFI leadership will work with the patient advisory council to determine what support can be provided for these transitions.
What will happen to all of Dr. Patrick’s patients?
As with any physician practice, upon retirement the physician and respective medical department will coordinate ongoing medical care for existing patients. In this case, this would include any CFI patient still within the 6-month window of referral. For those former patients who have completed their 6 months of cardiac rehabilitation and continue to utilize the CFI facilities, LHSC will ensure they receive their CFI chart so that they can be reassessed by their family physician to determine what medical follow-up care – including stress testing and/or referral to a new cardiologist – is required. CFI members will need to conduct their ongoing fitness activity at a community-based facility, as is the model across Ontario.
Will there be any staff layoffs as a result of this closure?
LHSC is meeting with impacted staff and we will work to mitigate any job loss.
How is the Cardiac Fitness Institute different than the St. Joseph’s CRSP?
Both programs help post-cardiac event patients to resume productive and active lives by learning how to manage cardiovascular risk factors, exercise safely, eat a heart-healthy diet, etc. CFI patients have had the option to continue their exercise program using equipment at the Cardiac Fitness Institute. No other cardiac program in Ontario provides an ongoing fitness service and these services do not fall under the mandate of acute care hospitals like LHSC.
Are the criteria for referral different at CFI versus St. Joseph’s CRSP?
The criteria for admission into any provincially funded cardiac rehabilitation program are established through CorHealth Ontario (formerly the Cardiac Care Network) and by physician referral.
What are the long-term outcomes of cardiac patients who have received rehabilitation through the CFI compared to those at St. Joseph’s CRSP?
We have no data that compares the outcomes.
Did Dr. Patrick retire because of this decision?
No. Earlier this year, Dr. Patrick advised LHSC of his intent to retire. This was a natural point to review the viability of this program in light of the ongoing funding constraints that LHSC faces.
Is there no other physician willing to take over the CFI?
The provincially funded cardiac rehab physician resources are already located at St. Joseph’s; hence the decision to consolidate the program to where the resources already reside. LHSC has no provincial funding to sustain this program which does not fall under the mandate of acute care hospitals in Ontario.
How is this decision in the best interest of patient care?
CorHealth Ontario (formerly called the Cardiac Care Network) and Ministry of Health and Long-Term Care developed the care pathway, including the rehab model, for cardiac patients and your question is best directed to them.
How are you helping patients transition to the six-month program at CRSP? What support is in place?
All new post-acute cardiac patients will be referred to St. Joseph’s CRSP starting in March 2018. The majority of post cardiac event patients needing these services are already referred to the CRSP program by cardiology so the referral process is well established. LHSC is committed to ensuring that all patients referred to CFI prior to March 2018 receive six months of cardiac rehabilitation care.
What are the options for patients once the six-month program is completed?
The Cardiac Rehabilitation and Secondary Prevention program at St. Joseph’s Health Care London can better advise you of that.
What about patients who can’t afford a fitness membership?
These are matters that were considered by CorHealth Ontario (formerly called the Cardiac Care Network) and Ministry of Health and Long-Term Care in the development of this care pathway for cardiac patients and your question is best directed to them.
If the government supports only the six-month program, why has the CFI continued to operate for such a long period of time?
Over the past several years the CFI patient council has raised funds to offset costs of operating the CFI program; however LHSC still subsidizes about 50% of the $300,000 annual costs of operating the CFI. The CFI program has been under increased scrutiny for the past several years as the funding environment has become increasingly challenging for LHSC, leading to the decision to wind it down.
How much money has been raised by CFI supporters and what is happening with it?
We have proposed to the CFI patient advisory council that we will work with them to allocate the remaining monies (approximately $63,000) to help support the transition.
What will LHSC do with the physical space once CFI has closed?
There has been no final decision made about the use of physical space at this time.