Professional Documents
Culture Documents
ABSTRACT
Aerobic exercise and resistance training have been proven
to be beneficial for patients with heart failure. Current
reimbursement guidelines exclude these patients from our
traditional cardiac rehabilitation program, so at Newton
Wellesley Hospital a clinic model was developed for the
disease management and exercise of heart failure patients.
Key Words: heart failure, physical therapy, exercise
INTRODUCTION
Newton Wellesley Hospital (NWH) is a 289 bed
teaching hospital located about 15 miles west of Boston,
Massachusetts. Our Cardiovascular Health Center offers
6 Phase II cardiac rehabilitation classes, serving patients
after myocardial infarction, coronary bypass surgery,
valve surgery, and angina. In addition, we run a disease
management program for patients with heart failure (HF).
Referrals come from inpatient admissions for acute onset HF
and referrals from cardiologists and primary care physicians.
This HF clinic is a nurse practitioner (NP) based clinic that
offers disease management, education, exercise, and long
term follow-up. There are dieticians and physical therapists
involved in the education and exercise components of the
program. The program uses a multidisciplinary model,
which affords us the opportunity to incorporate each team
members expertise into a comprehensive patient care plan
that positively impacts outcomes.
The CHF program began in 1996 by a NP and a physical
therapist. The practitioners recognized the exclusion of HF
patients from traditional cardiac rehabilitation programs
and a more flexible, fluid, clinic model was developed. At
the beginning of the program there were only 5 patients
enrolled at a time, building gradually, with an estimated
500 patients participating to date. The current enrollment
includes 64 patients for the exercise class, which is offered
twice per week. Patients range in age from 52-92 years,
33 males and 31 females. The diagnosis of diastolic HF
accounts for approximately 70% of the current group of
patients, with the remainder diagnosed with systolic HF.
At NWH we have an identify and connect program that
Address correspondence to: Ann Knocke MS, PT, CCS,
Newton-Wellesley Hospital, Washington Street, Newton, MA Ph: (617) 243-6172 (aknocke@partners.org).
46
Nursingcheck in
Weight
Heartrate
Bloodpressure
Lungandheartsounds
Legedema
CliniclevelII:
Twiceweeklynursing
assessment,exercisesession
withphysicaltherapists
ExerciseSession
6months
5minwarmup
CliniclevelI:
Maintainance:
Onceweeklynursing
assessment,exercisesession
withphysicaltherapists
Physicaltherapistassessment
andexercisesession
3months
3months
2030minaerobicexs
5mincooldown
strengthtraining
CheckoutbyPT
Figure 2. The 3 phases of the heart failure clinic.
5minseatedrest
HRandBP
Bloodsugar
Figure 1. Examination and management of patients in the heart failure clinic.
Erratum
The complete radiograph from Sobush et al (June 2012 issue) was
inadvertently cut off. The full image is reprinted here.
47