The Solution to Cardiac Rehabilitation
Activate Your Heart (AYH) is an online, interactive cardiac rehabilitation programme designed to support individuals who have had a recent cardiac event, or with a pre-existing heart disease. The programme offers a package of secondary prevention advice aiming to reduce the risk of a further cardiac event and improve an individual's well-being by promoting a healthy lifestyle. The programme has personalised interactive features that include an individualised exercise programme, stress management and smoking cessation support (if appropriate). There is direct access to a health care professional through the 'ask the expert' facility and an interactive forum for all participants to join that is moderated by experts in cardiac rehabilitation. This represents an opportunity for improved quality-of-life for patients, as well as for cost savings for healthcare providers by reducing readmissions. The strength of this programme is that is developed and supported by a leading team of healthcare professionals; there is also the ability to offer a managed service to organisations adopting the technology.
AYH was developed by a team of rehabilitation specialists at University Hospitals of Leicester (UHL), led by Professor Sally Singh.
The Problem in Cardiac Rehabilitation
The idea arose because of the poor uptake for cardiac rehabilitation and the need to develop effective and viable alternatives that would appeal to a number of candidates for cardiac rehabilitation. Despite offering a significant reduction in patient mortality following a cardiac event, uptake of cardiac rehabilitation services is nationally low. The National Audit of Cardiac Rehabilitation reported that as few as 45% of patients eligible for rehabilitation in the UK were participating in a programme. Whilst there are regional differences in rehabilitation services offered to patients, adherence to programmes is a critical factor and patients frequently state that timing of appointments, travel to clinics and family commitments affect their participation. AYH offers the advantage as an online tool that it can be used remotely, and is therefore time and location independent. The programme allows participants to log their own progress that is also monitored remotely by the rehabilitation team and provides an opportunity for communication with the team, should the patient have questions or concerns.
Current AYH implementations
AYH has been rolled out across Leicestershire and there is evidence that patients using the programme demonstrate and improvement in exercise capacity, quality of life and dietary habits following participation. The Cardiac Rehabilitation Service at UHL has seen an increase in the number of patients using their services since the introduction of AYH.
NHS Scotland carried out an evaluation of web based CR using Activate Your Heart (AYH) over an 18-month period, during which 33 patients completed the digital CR programme. AYH was chosen for provision of digital access to CR services in Scotland with a view to increasing CR provision to a larger patient population in line with increased referrals and demand on the service, but to also increase CR menu of options available to patients thereby increasing capacity.
Leeds Community Healthcare NHS Trust has recently licenced the programme. In addition, the Department of Work and Pensions licenced the programme as part of its ‘Fit for Work’ scheme.
Future plans for AYH include expanding access to the programme across the NHS and, potentially to private healthcare. In addition, options for accessing the programme on different platforms are being explored and a mobile version for smart phones has been developed. Most recently the team have begun to develop a specific module for those with chronic heart failure, these patients typically present with subtly different symptoms, notably breathlessness and fatigue and, therefore, require a different approach to improve overall exercise performance and well-being. The team at UHL will continue to evaluate and improve the programme as new evidence comes to light.
• In relation to patient AYH site use:
‘it was straightforward, I understood what it was for and I got going, my wife and I both looked at it together.’
• In relation to dash board widgets:
One patient found the Q&A function helpful and the ability to check out stories, which had been heard or read in the media about ‘heart health’, diet or exercise; ‘when a story was in the paper or on the television about food and heart problems, I would use AYH to look up information’
The ‘Blog’ site was also considered useful by this patient:
Although they had not directly participated, they had found it useful to read what others were saying about their experiences of CR.
• In relation to whether the online web based AYH option made a positive contribution to rehabilitation:
All patients felt AYH had been a positive part of their rehabilitation.
‘useful, fitting in with my lifestyle and working well’
Another patient stated that they went through all of the stages, which gave them a feeling of accomplishment;
‘Yes. It was positive, because it gave me a regime to follow and it worked for me. I lost weight, walking regularly and checked my weight daily. Losing approximately 1 stone.’
‘I would certainly recommend it to someone else, if it fitted into their lifestyle.’
‘it would be useful to help other people make commitments to do exercise regularly and setting goals was especially helpful in the early days of rehabilitation.
One patient had had further cardiac symptoms and had used AYH to read about them, stating: ‘even though they cannot diagnose online, it’s reassuring there is someone there’.
For information, please contact:
University Hospitals of Leicester