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July 2016 Br J Cardiol 2016;23:(3) doi: 10.5837/bjc.2016.024 Online First

Development of a UK National Certification Programme for Cardiac Rehabilitation (NCP_CR)

Gill Furze, Patrick Doherty, Carol Grant-Pearce

Abstract

In 2012, the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) published guidance on the standards and core components of cardiac rehabilitation (CR). However, annual reports from the UK National Audit of Cardiac Rehabilitation (NACR) have shown that, while there are examples of excellent practice in the UK, many CR programmes do not meet the BACPR standards. It is difficult for service managers, patients and commissioners to assess how a particular CR programme meets minimum standards of service delivery. These findings led the BACPR and NACR to work together to develop a UK National Certification Programme for CR that would be mainly based on assessment of quality-assured patient-level NACR data. The development of the certification process was built on surveys and interviews with CR service providers, patients and commissioners. Minimum standards for certification were developed by an expert group. The resulting process for certification of meeting minimum standards of CR service was then successfully pilot-tested with 16 CR programmes, of which 13 programmes have since met minimum certification standards. CR programmes that submit data to the NACR can now apply for assessment under the BACPR/NACR National Certification Programme.  

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July 2016 Br J Cardiol 2016;23:(3) doi: 10.5837/bjc.2016.025 Online First

Spinal cord stimulation for refractory angina: 100 case-experience from the National Refractory Angina Service

Blandina Gomes, Kamen Valchanov, William Davies, Adam Brown, Peter Schofield

Abstract

Refractory angina represents an important clinical problem. Spinal cord stimulation (SCS) for refractory angina has been used for over two decades to improve pain and, thus, quality of life. This case series reports the clinical efficacy and safety profile of SCS.

We included patients who had a SCS device implanted between 2001 and 2015 following a rigorous selection process. Patients were prospectively followed. We performed a descriptive analysis and used paired t-test to evaluate the difference in Canadian Cardiovascular Society angina (CCS) class before and after SCS implant.

Of the 100 patients included, 89% were male, the mean age was 65.1 years and mean follow-up time was 53.6 months. The CCS class after SCS implant was statistically improved from before (p<0.05) and 88% of patients who gave feedback were very satisfied. Thirty-two patients died, 58% of those who had a documented cause of death, died from a non-cardiac cause.

This study shows the outcome of 14 years’ experience of SCS implantation. The anginal symptoms had a statistically significant improvement and the satisfaction rate was higher than 90%. The complication rate is within the range reported in the literature. SCS seems to be an effective and safe treatment option for refractory angina.

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June 2016 Br J Cardiol 2016;23:57–60 doi: 10.5837/bjc.2016.019

The short- and long-term impact of psychotherapy in patients with chronic, refractory angina

Peysh A Patel, Murad Khan, Chia Yau, Simerjit Thapar, Sarah Taylor, Paul A Sainsbury 

Abstract

Refractory angina (RA) describes those patients with persistence of symptoms despite optimal conventional strategies. It is often associated with a maladaptive psychological response, resulting in significant burden on hospital services. This observational study sought to assess the short- and long-term impact of psychotherapy on quality of life, mood and symptoms. 

Between 2011 and 2012, consecutive attendees to a specialised RA service were recruited. Intervention consisted of a course of cognitive-behavioural therapy allied with an education programme. Outcome measures were collated pre-intervention, one month and two years post-intervention. Validated questionnaires were utilised for scoring assessments: SF-36 (Short-Form 36) for quality of life, HADS (Hospital Anxiety and Depression Scale) for anxiety/depression, and SAQ (Seattle Angina Questionnaire) for functional assessment. 

There were 33 patients included. Median SF-36 scores increased and this effect remained in the long term. Levels of depression reduced, and improved further at subsequent review. Frequency of angina was comparable, both short and long term. Usage of glyceryl trinitrate (GTN) spray was similar at one-month follow-up and at two years. 

In conclusion, a short course of psychotherapy appears to improve quality of life and mood in patients with RA, and is achieved independent of symptom control. Further research is warranted so that the debilitating morbidity associated with this disorder can be abrogated.

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June 2016 Br J Cardiol 2016;23:61–4 doi: 10.5837/bjc.2016.020

Clinical and psychological outcomes of an angina management programme

Deborah Tinson, Samantha Swartzman, Kate Lang, Sheena Spense, Iain Todd

Abstract

Chronic refractory angina results in significant NHS costs due to chronic high use of resources. This audit evaluated the clinical effectiveness of a cognitive-behavioural (CBT) programme in reducing angina symptoms after maximal medical and surgical intervention. The primary outcome was self-reported angina. Additional questionnaire data comprised perceived quality of life/disability, angina misconceptions, self-efficacy and mood. Data from the electronic patient administration system was used to compare use of cardiology hospital resources in the two years before and two years after attendance. Patients completing questionnaires reported significant improvements in all areas post-group and at two months. Resource use was lower in the two years post-programme than the two years prior. A CBT-based approach to symptom management could offer additional clinical benefits in the cardiac rehabilitation menu.

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