Postcode lottery threat to heart care

By Jane Elliott
Health reporter, BBC News

David and Jeanni Lamb felt the rehab programme was lacking

When David Lamb turned up for rehab care following his heart attacks he was so disillusioned he only attended one session and did not go back.

Research has shown that patients, like David, attending cardiac rehabilitation improve their chances of surviving in the first five years by more than a quarter, at a cost to the NHS of just £600 per patient.

But in some areas, according to the British Heart Foundation (BHF), just one in seven people get the support they need.

And three out of five cardiac patients do not have access to rehab services at all.

Awareness campaign

The BHF, which has launched a campaign to increase awareness, says people are dying needlessly and that further cuts loom.

Mr Lamb, aged 49, from south Wales, had two heart attacks and staff at his local hospital suggested he might benefit from a cardiac rehab programme - specially designed to help people like him get back to work.

I wanted someone to help me with this not someone who just kept saying 'you can't do this, you shouldn't do that' David Lamb

But he and his wife felt the service they were offered was very poor and inadequate.

"We went for the session to a local nursing home and the first thing they did was to offer us coffee and biscuits, which I thought was strange considering I had just had a heart attack and was supposed to be watching my weight."

David said the nurse then started asking him a series of questions, but excluded his wife from the conversation, despite the fact that she had been encouraged to attend.

Heart patients who do not take cardiac rehabilitation are 25% more likely to die in the following two to five years Cardiac rehab helps people make necessary changes When rehab is properly resourced it can cut hospital admissions

He said the nurse also appeared not to have his medical files and got him to do physical tests that he had already completed and surpassed in hospital.

"I was just 49. I had been active and was keen to get back my life. I wanted someone to help me with this, not someone who just kept saying 'you can't do this, you shouldn't do that'.

"We did not go to any further sessions. Anything we needed to find out about cardiac rehabilitation we then found out from the internet."

His wife Jeanni agreed, saying that despite being expressly asked to become involved she had felt 'marginalised' and they had both been dispirited.

"It seemed like they were just running the course so that they could say that they had done it and to tick the boxes."

'Rehabilitation aids recovery'

The BHF has now launched a campaign against what it calls a "postcode lottery of services".

Currently, south west London has the lowest rate of cardiac rehabilitation, with only 14% of patients receiving treatment, while the highest level, 73%, is in Greater Manchester.

The BHF says a rehab programme, which should last an average of 12 weeks, should involve nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups.

They should provide patients with ongoing advice and support, including information on improving lifestyle and diet and a structured exercise programme.

If this is carried out, they say, the patients will have a better understanding of their condition and a better quality of life.

It can work

Professor Bob Lewin of the BHF said: "With cardiac rehabilitation, many of those lives can be saved, and the quality of life for heart patients can improve dramatically.

"This cost-effective treatment has also been proven to reduce hospital readmission, which is not only better for the patient, but also reassures health services commissioners that they're allocating funds in the most sensible way".

And the BHF says cases like that of Sue Kelly, 51 and from Worcestershire, are proof that the system can and does work if it is properly implemented.

Sue said: "I was lucky enough to have support from a cardiac rehabilitation nurse who took the time and patience to introduce me to ways of coping with what had happened.

"We had talks on medication, diet, relaxation, exercise, stress, returning to work and all the other life activities one does.

"Gradually I could see a light at the end of a tunnel and my optimism for life returned.

"I can honestly say that without cardiac rehab, I probably would have given up and who knows where I would be today."