Have you seen this great picture?  Former NCCRA President Mike Dunlap uses to educate his patients about small vessel disease.  Here is what he shares with them:

Small vessel disease is a condition in which the walls of the small arteries in the heart are damaged. The condition causes signs and symptoms of heart disease, such as chest pain (angina).

Small vessel disease is sometimes called coronary microvascular disease or small vessel heart disease. It’s often diagnosed after a doctor finds little or no narrowing in the main arteries of your heart, despite your having symptoms that suggest heart disease.

Small vessel disease is more common in women and in people who have diabetes or high blood pressure. The condition is treatable but can be difficult to detect.  The large vessels in your heart can become narrowed or blocked through a condition in which fatty deposits build up in the arteries (atherosclerosis).

In small vessel disease, damage to the small vessels affects their ability to expand (endothelial dysfunction). As a result, your heart doesn’t get enough oxygen-rich blood.  “Mayo Clinic Website”

This photo of the thousands of blood vessels in the heart really drives home the point that the potential for CAD doesn’t lie just in the major coronary arteries.  We have this photo as our background on our classroom TV/computer screen.  Whenever we have an education class, our patients see this photo.  I hope it motivates them to take more responsibility in preventing the progression of their CAD.  I’m quick to tell patients that if they already have disease in the major arteries of the heart, what are the chances you don’t also have small vessel disease.  And we remind them that regular cardiorespiratory exercise is one of the best ways to treat this.

Thanks Mike!  What educational tools or teaching points do you use with your patients.  Please share with us!

We would like your feedback as we make future plans for our annual meeting. Please complete this survey and forward the link to others that work within CVP rehab in our state. We appreciate your participation!

https://www.surveymonkey.com/r/K28DYXK

Have you been signing in for the regular webinar through Million Hearts?  It’s a great resource to hear about what your colleagues are doing to increase enrollment and better meet our patients needs.

https://millionhearts.hhs.gov/tools-protocols/tools/cardiac-rehabilitation.html

Most recently they provided some great resources including recordings of past webinars.  Check it out!

Slides – Million Hearts Cardiac Rehabilitation 101 webinar_10202020Slides – Million Hearts Cardiac Rehabilitation 101 webinar_10202020

Working Draft – New Cardiac Rehabilitation Models in the US_10202020

Million Hearts Cardiac Rehabilitation Webinar Series – Recordings and Resources

 

 

Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries

Peter K. Lindenauer, MD, MSc^1,2,3; Mihaela S. Stefan, MD, PhD^1,2; Penelope S. Pekow, PhD^1,4; et alKathleen M. Mazor, EdD⁵; Aruna Priya, MA, MSc^1,4; Kerry A. Spitzer, PhD, MPA¹; Tara C. Lagu, MD, MPH^1,2; Quinn R. Pack, MD, MSc^1,2,6; Victor M. Pinto-Plata, MD^2,7; Richard ZuWallack, MD⁸

Author Affiliations

JAMA. 2020;323(18):1813-1823. doi:10.1001/jama.2020.4437

 

 

Key Points

Question  Is initiation of pulmonary rehabilitation after hospitalization for chronic obstructive pulmonary disease (COPD) associated with better survival?

Findings  In this retrospective observational study that included 197 376 Medicare beneficiaries discharged after hospitalization for COPD, initiation of pulmonary rehabilitation within 3 months of discharge, compared with later or no initiation of pulmonary rehabilitation, was significantly associated with lower risk of mortality at 1 year (hazard ratio, 0.63).

Meaning  These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.

Abstract

Importance  Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge.

Objective  To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival.

Design, Setting, and Patients  This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015.

Exposures  Initiation of pulmonary rehabilitation within 90 days of hospital discharge.

Main Outcomes and Measures  The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality.

Results  Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD], –6.7% [95% CI, –7.9% to –5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD, –4.6% [95% CI, –5.9% to –3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD, –11.1% [95% CI, –13.2% to –8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01).

Conclusions and Relevance  Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.

Editor’s Note: Pulmonary Rehabilitation has tended to publish results related to improved functional capacity, improved quality of life and reduced hospitalizations. This article points out a significant mortality benefit. All of these outcomes are extremely important and the mortality benefit is very important to the physician community.

The referral rate for PR continues to be around 10% of eligible patients, most of whom have severe or highly severe lung function. We need to examine ways to recruit patients at a stage of the disease where there is a greater rehab potential. We also need to encourage physicians to include simple spirometry as a part of the physical exam especially in older patients and patients who have a significant history of smoking.

Cardiac and pulmonary rehab professionals – it is time to act!

In March, representatives from NCCRA joined AACVPR in their efforts in Washington, DC to gain support for the Sustaining Outpatient Services Act.  This Act has the potential to directly affect the ability of cardiopulmonary rehab departments from growing and in some cases, remaining open.

This bill will exempt certain hospital outpatient services from a drastic reimbursement reduction that are based solely on the location of the hospital outpatient service which is explained in depth in the Legislative Priority (https://www.aacvpr.org/Portals/0/DOTH/2020/Legislative%20Priority_AACVPR_2020_6-20.doc)

Now we need your help to get this included into legislation that will be considered by the legislation in July. 

Please support and assist in getting this legislation moved forward by taking part in the follow-up letter writing campaign. Template follow-up email letters requesting sponsorship (signature) of these bills will be posted on the DOTH advocacy web page. The virtual lobbying tool used this spring has been put on hold during this interim, so template letters and how to contact your US Congressional members are on the Advocacy web page and can also be found below.

How to find your U.S. House Representative: For the contact information of your House Representative, click here.

How to find your U.S. Senators: For the contact information of your two Senators, click here.

Letter to co-sponsor the Senate bill:

https://www.aacvpr.org/Portals/0/DOTH/2020/Introduction%20letter%20to%20co-sponsor%20Senate%20bill%20S.4151.docx

Letter to co-sponsor the House bill:

https://www.aacvpr.org/Portals/0/DOTH/2020/Introduction%20letter%20to%20co-sponsor%20US%20House%20bill%20HR4838.docx

The NCCRA Board will be hosting a few online conversations that will allow our membership to hear about the current status of a few programs across the state and then engage in a round table discussion. We hope this will be helpful to our membership as they navigate this new landscape of the COVID19 pandemic.  The dates that are currently planned include:

Wed, May 27 at 1pm and Friday, May 29 at 2pm.

If you are interested in attending please rsvp to  info@nccraonline.org and let us know what date you are interested in participating in.

We look forward to a great discussion!

These are  great resources that can help support our programs and patients during this time:

http://www.aacvpr.org/covid19

https://www.henryford.com/services/cardiology/support/cardiac-rehab/home-based-cardiac-rehabilitation.

Cardiosmart videos https://www.cardiosmart.org/Videos

Heart failure:  https://www.cardiosmart.org/News-and-Events/2019/09/Learning-to-Live-With-Heart-Failure

https://www.cardiosmart.org/News-and-Events/2018/04/Managing-Heart-Failure

PAD https://www.cardiosmart.org/News-and-Events/2013/12/Video-Peripheral-Artery-Disease

LVAD

https://youtu.be/OQJfCUrvBBI

Coping with your emotions

Cardiac come back  https://shar.es/aHYdYw

Dealing you’re your emotions after a heart attack:  http://healthlibrary.vidanthealth.com/MultimediaRoom/AnimationsPlus/#vm_A_2314a147

Depression and CAD https://www.cardiosmart.org/News-and-Events/2013/12/Video-Depression-and-Heart-Disease

Cardiac curriculum

https://www.healtheuniversity.ca/EN/CardiacCollege/Pages/learn-online.aspx

Patient Education Resources

 

Send us others that you feel need to be added to this list!

 

We hope you are all remaining healthy and well.  It seems that many programs are either closed or working at decreased capacity right now.  Since our state symposium was cancelled, we wanted to share the changes in our NCCRA Board as of today.  Usually when you agree to a position as a Regional Vice President our bylaws require you to serve in that capacity for three years.  During that time you host yearly fall meetings for your region. We are so very happy to announce Jeff Soukup will be taking on this roll for the coastal region!  Congratulations Jeff and welcome to our NCCRA Board.  Susanne Bice and Beth Ann Scott will remain as the Piedmont and Mountain Vice Presidents.

We also want to congratulate Kelly Forrest as she moves from the Coastal VP position into the Incoming President role, Jennifer Simmons is now in the role of President and Candace Langston is the Immediate Past President.

We look forward to a productive year for the NCCRA and we hope that our membership stays safe, healthy and well.