Rehabilitation is the heart of the matter

Cardiovascular disease is a leading cause of death and disability in the UK and much campaigning has been done to raise awareness of the causes, prevention and treatment. But effective rehabilitation following a cardiac event is often left behind, reflects consultant cardiologist Dr Ajay Jain.

The NHS is facing another incredibly tough winter, with waiting lists remaining stubbornly high and patients in need of cardiac care are facing a real dilemma. 

Once discharged after a cardiac event, many patients are waiting months to begin rehabilitation during what is an undoubtedly critical window.

We must all work together to achieve the best patient outcomes and the independent sector has an incredibly important role to play in this, as well as easing the burden on our national health service. 

The benefits of cardiac rehabilitation are well documented and there is a strong evidence base for reducing mortality and morbidity associated with cardiovascular disease.

Guidelines developed by the National Institute for Health and Care Excellence (NICE) strongly recommend that individuals who have suffered from a heart attack are provided with timely access to comprehensive cardiac rehabilitation, which should include vigorous exercise, high-quality health education and stress management.

Vital rehabilitation 

This is further supported by the British Heart Foundation, which has highlighted that cardiac rehabilitation is vital for a patient’s long-term recovery, considering it as important as taking medicine; with regular exercise being a critical part of this. 

Indeed, for those who have experienced a myocardial infarc­tion and/or coronary revascular­isation, attending cardiac rehabilitation provides a 2.8% reduction in cardiovascular mortality, as well as reducing acute hospital re-admissions. 

Our approach as a sector to cardiac rehabilitation has previously been inconsistent at best, with many patients being discharged from private care back to the NHS to receive their rehabilitation.

This means that while we are helping deal with immediate, often emergency situations, we may be delaying evidence-based rehabilitation interventions which ultimately keep patients out of hospital. 

St Bartholomew’s Hospital is one of Europe’s leading NHS specialist heart centres and earlier this year the first full-scale independent hospital in the City of London opened its doors on its campus. 

Nuffield Health at St Barth­olomew’s Hospital has launched a new cardiac rehabilitation programme to support cardiac patients seen at the Nuffield Health’s hospital, a unique offering in the industry. 

Driven by Nuffield Health’s approach to building a healthier nation, we are proud to be pioneering an end-to-end programme which takes a preventative look at heart health and provides rehabilitation across the entire patient pathway, including providing support for both mental and physical health. 

Empowering patients 

Cardiac rehabilitation is more than just undertaking vigorous exercise. There is a deep focus on ensuring that patients are empowered to make the right decisions for their own health in a sustainable and manageable way. At the heart of this is making lifestyle changes. 

This is underpinned by our approach to connected healthcare, which enables us to provide holistic services to all our patients, helping to make sure they stay fit and healthy throughout their hospital journey and, crucially, throughout their entire lives. 

The Nuffield Health team of specialist personal trainers, physiotherapists, emotional well-being counsellors, and nutritionists work in close collaboration between the hospital and nearby Fitness & Wellbeing Centre in Barbican so that we can fully understand a patient’s needs and provide them with personalised care. 

As the Covid-19 pandemic begins to gradually recede and our collective attention once again falls towards the wider therapy areas such as cardiovascular care, it is more important than ever that we develop a preventative approach to healthcare that helps stop people requiring hospital services in the first place. 

At the core of the NHS Long Term Plan is a commitment to support people keeping healthier for longer through a preventative approach to healthcare.

We at Nuffield Health at St Bartholomew’s Hospital fully recognise that achieving this goal is a challenge, but one we must aim to achieve.  

Our cardiac rehabilitation programme offers support for anyone who has heart disease or is concerned they might be at risk of developing it. 

Lifestyle changes 

Our specialist nurses, physiotherapists and exercise specialists help identify lifestyle changes that would most benefit an individual’s heart health and the eight-week programme combines exercise with education and well-being support. 

Supervised exercise at Nuffield Health’s fitness and well-being centres helps to increase physical fitness and confidence, while heart health education helps provide patients with knowledge with how to improve heart health, with the overarching aim of avoiding re-admittance into hospital. 

Emotional well-being sessions are also offered, helping to deal with the sometimes-profound after-effects of a heart event, as well as looking at reducing potential lifestyle triggers such as stress.

We fully appreciate the work that the NHS is doing in tackling the backlog and we welcome the NHS and Government’s decision to put cardiac care as a core pillar of healthcare policy. 

The establishment of new initiatives for GPs like Directed Enhanced Services (DES) is an excellent step in better identifying early signs of cardiac issues.

However, the independent sector has an important role to play in helping the NHS to effectively meet these patient’s needs, and taking a fully connected, preventative approach may mean that fewer patients will be required to go back into the system, relieving the pressures for longer. 

Our approach to cardiac rehabilitation is leading the way in this, and we strongly believe that the wider independent sector has an important role to play in supporting the NHS in this difficult time by taking a similar approach. 

At Nuffield Health at St Bartholomew’s Hospital we are urging cardiologists and GPs to refer to us those patients who would benefit from our services and ensure that they can receive the comprehensive care and treatment they deserve. 

That way, we can help build a healthier nation for all.

Dr Ajay Jain (right) is a consultant cardiologist at Barts Heart Centre, part of Barts Health NHS Trust, and is also a consultant cardiologist at Nuffield Health at St Bartholomew’s Hospital in London. 

He is the clinical lead for the nationally renowned Heart Attack Centre, among  the busiest and most effective centres of its type in the UK. His clinical interests include chest pain, hypertension and structural heart disease. Dr Jain performs closure of patent foramen ovale and renal sympathetic nerve ablation and acts as proctor for several of these procedures. 

He sits on the Guidelines and Standards Committee for the British Cardiovascular Interven­tion Society.