The following information posted in January 2018:

LHSC to end referrals to the Cardiac Fitness Institute (CFI) in March 2018

Contents:

Update on transition of Cardiac Fitness Institute services to provincial model of care

Why is the care model being changed?
As an academic health sciences centre, LHSC adheres to evidence-based decision making when it comes to how patient care is delivered. The decision to wind down the Cardiac Fitness Institute is an outcome of that approach, in that the Cardiac Rehabilitation and Secondary Prevention Program at St. Joseph’s Health Care London aligns directly with the latest national and provincial recommendations for post-cardiac event care and already serves more than 90% of these patients in London. In winding down the CFI, going forward all patients will benefit from the latest standards of care, which are informed by evidence-based guidelines.

How does the provincially-adopted model work?
Physician-referred patients with known heart disease – for example, those who have had a heart attack, angina, angioplasty or heart surgery – enter a six-month program. In this program, they work with a professional team (including cardiologists, cardiac rehab specialists, registered nurses, kinesiologists, dietitians, clinical psychologists and support staff) to create and follow an individualized program.

During the program, patients receive medical management, an exercise program, cardiac risk factor counseling, and education sessions. In addition, there is an emphasis on comprehensive behavioural modification therapy designed specifically to help patients manage their cardiovascular risk factors in order to resume a productive, active and satisfying lifestyle.

As a result, patients gain new knowledge, skills and confidence to help them recover, learn to self-manage their health, and reduce their chances of having another heart event. This includes the improvement of their physical functioning and emotional well-being that can enhance overall quality of life, better understanding of their condition and support from other patients with heart conditions.

Upon completion of the program, patients are provided with an updated exercise plan taking into consideration their progress throughout cardiac rehab and the results of a repeat exercise test. Program staff remain accessible to them should they have any subsequent questions about their ongoing rehabilitation in order to self-manage effectively.

After the program, patients are discharged back to the care of their family doctor with a comprehensive summary covering all areas of intervention and progress, including risk factors, medications, health behaviours, emotional health and exercise capacity. The family physician carefully reviews the information with the patient.

Additionally, patients are encouraged to continue their exercise and health behaviour regime in the community. Much of the initial program work is to prepare the patient to have the knowledge, skills and confidence to carry out fitness regimes on their own in the community.

Patients are provided with a comprehensive list of community resources, including fitness gyms and contact information. One-on-one discussions are also held with patients to talk about their options and what would work best for their long-term success and sustainability.

In support of the model, Dr. Cathy Faulds, Family Physician and Chief Clinical Lead, South West Local Health Integration Network, notes that:

“I have great confidence that the Cardiac Rehabilitation and Secondary Prevention program offered at St. Joseph’s Health Care London will provide best practice cardiac rehabilitation for all patients in our London Middlesex region. In partnership with family physicians, this model ensures that patients are provided the secondary preventative care they need and the tools to effectively self-manage their care, and also facilitates a graduation to a community-based exercise program.”

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How will CFI patients be supported with this transition to the latest care model?

Dr. Raymond Yee, City-wide Chair Chief of Cardiology at London Health Sciences Centre and St. Joseph's Health Care London, is helping in the transition process for patients. Dr. Yee notes:


“As a cardiologist and a researcher, I fully support the clinically proven provincial model for cardiac rehabilitation care delivered at St. Joseph’s Health Care London that was developed by cardiologists from across Ontario, and reflects best medical practice for cardiac patients. While we understand this change may create concern for those affected, we are fully committed to working with CFI participants in the weeks ahead to ensure an appropriate transitional care plan is in place for them.”

The transition support will include three scenarios:

  1. Patients who have experienced a new cardiac event requiring acute care
    More than 90% of new referrals for cardiac rehabilitation services in London are currently referred to the Cardiac Rehabilitation and Secondary Prevention Program (CRSP) at St. Joseph’s Health Care London. When the CFI stops receiving referrals in March 2018, all post-acute cardiac event patients will be directed to the CRSP program. LHSC is committed to ensuring that all patients referred to CFI prior to March 2018 receive six months of cardiac rehabilitation care.

  2. Long-term CFI patients who routinely utilize the fitness centre
    There are patients who access the Cardiac Fitness Institute each week to exercise. LHSC will be working with the CFI’s Patient and Family Advisory Committee to hear ideas about how we can best transition these patients to a community fitness setting and move to a self-management model. LHSC is committed to assisting members to find solutions that address their individual concerns.

  3. Transition of patients under Dr. Patrick’s care who have accessed CFI for routine follow-up appointments including stress testing
    CFI patients have attended annual or semi-annual follow-up appointments at the CFI clinic with Dr. Patrick; some have continued to attend the clinic up to several decades. Upon Dr. Patrick’s retirement, LHSC will be working with cardiologists in its Department of Cardiology and Dr. Patrick to ensure that delivery of secondary cardiac prevention is maintained as per best practice for these patients as they transition to ongoing care with their primary care provider and/or a cardiologist.

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A message from LHSC:

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 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.

Given these realities, and after consultation with St. Joseph’s Health Care London, CorHealth, and the South West 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.

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Frequently Asked Questions

Why are you closing the program?
As an academic health sciences centre, LHSC adheres to evidence-based decision making when it comes to how patient care is delivered. The decision to wind down the Cardiac Fitness Institute is an outcome of that approach, in that the Cardiac Rehabilitation and Secondary Prevention Program (CRSP) at St. Joseph’s Health Care London aligns directly with the latest national and provincial recommendations for post-cardiac event care and already serves more than 90% of these patients in London. In winding down the CFI, going forward all patients will benefit from the latest standards of care, which are informed by evidence-based guidelines.

How many patients are affected by the closure?
The most recent data indicates that approximately three patients per month are referred to the CFI. There are about 250 patients who have continued to utilize the exercise facilities at CFI on an ongoing basis.

What happens to patients that have been using the ongoing fitness service?
LHSC will be working with the CFI’s Patient and Family Advisory Committee to hear ideas about how we can best transition these patients to a community fitness setting and move to a self-management model. LHSC is committed to assisting individual members to find solutions that address their individual concerns.

What will happen to all of Dr. Patrick’s patients?
CFI patients have attended annual or semi-annual follow-up appointments at the CFI clinic with Dr. Patrick; some have continued to attend the clinic up to several decades. Upon Dr. Patrick’s retirement, LHSC will be working with cardiologists in its Department of Cardiology and Dr. Patrick to ensure that delivery of secondary cardiac prevention is maintained as per best practice for these patients as they transition to ongoing care with their primary care provider and/or a cardiologist.

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. The St. Joseph’s CRSP aligns directly with the latest national and provincial recommendations for post-cardiac event care, including helping patients develop an ongoing self-management model that transitions them to a community fitness program.

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.

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 where well over 90% of all patients requiring such care are already served; so consolidating the program to where the resources already reside was a natural step.

How is this decision in the best interest of patient care?
Consistent with the latest in national and provincial recommendations for post-cardiac event care, the Cardiac Rehabilitation and Secondary Prevention Program at St. Joseph’s Health Care London has cared for approximately 14,000 since its inception. The CRSP program follows the care pathway, including the rehab model for cardiac patients, developed by CorHealth Ontario (formerly called the Cardiac Care Network) and Ministry of Health and Long-Term Care.

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?
LHSC will be working with the CFI’s Patient and Family Advisory Committee to hear ideas about how we can best transition these patients to a community fitness setting and move to a self-management model. LHSC is committed to assisting individual members to find solutions that address their individual concerns.

What is happening with money raised by CFI supporters?
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.



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Last Updated March 27, 2018 | © 2007, LHSC, London Ontario Canada