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Benefits of a multidisciplinary method for Cardiovascular Disease Management

– Amelia Vitek,  Exercise Physiology at Optimum Health Solutions Goulburn

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Cardiovascular disease affects millions of people around the world and is one of the leading causes of morbidity and mortality. Cardiovascular disease is the name for the group of disorders that involve the heart and blood vessels. Individuals affected by cardiovascular disease usually experience repeated hospital admissions, poor quality of life and shortened life expectancy. The period of time after a patient has been discharged from the hospital has been identified as one of the most vulnerable times for the patient. This time period has been identified as a time to transition from hospital to outpatient care.

multidisciplinary teams are effective and advised

The European Heart Journal currently states that multidisciplinary teams are effective (and advised) in the management post hospitalisation of heart failure. Post-discharge, enrolment in cardiovascular management programs, encompassing aspects of follow-up and monitoring, optimising medication, education and support and exercise prescription is important for improved outcomes. Multidisciplinary teams have been shown to aid in these improved outcomes, alleviate suffering and make the overall experience of outpatient care better for the patient and their families.

TRANSITIONING FROM HOSPITAL

When transitioning from an in-hospital admission to an outpatient program, one of the main goals for the multidisciplinary team is to deliver effective patient education. Information should be individualised to each patient to ensure the correct literacy level and readiness to learn is delivered. To ensure high retention levels, the information should be provided in small amounts and in regular intervals. Information can be provided in both oral and written formats, however, web-based videos can also be valuable learning tools. When appropriate, education can also involve the patients family and caregivers to ensure the continuation of care post-hospital admission. Multidisciplinary team members should regularly follow-up with patients (and their carers) to confirm their level of understanding. This is to ensure the patient is following the correct protocols and lifestyle to best assist in managing their cardiovascular disease.

team approach to a patient’s healthcare

A multidisciplinary method involves an integrated team approach to a patient’s healthcare. This means that the evaluation of treatment options and the treatment planning are collaborative processes involving medical and allied health professionals. Treatment plans that are individual and patient specific, become a shared responsibility among practitioners. There must be a high level of both written and oral communication between practitioners in order to deliver the highest level of care the patient. In regard to a multidisciplinary approach to an individual with cardiovascular disease, the team can involve a Cardiologist, Specialised Cardiovascular nurse, General Practitioner, Pharmacist, Dietician, Exercise Physiologist, Physiotherapist and Psychologist. The multidisciplinary team can be made up of any number of these practitioners. Some practitioners may work more acutely post hospitalisation (Physiotherapist, Dietician, and Pharmacist) and other practitioners will work long term (Exercise Physiologists, General Practitioners and Psychologist).

The benefit of structured exercise training

An Exercise Physiologist is an example of a member of a multidisciplinary team in treating an individual with cardiovascular disease. There is increasing evidence showing the significant benefit of structured exercise training on improvements for post-discharge outcomes for individuals with cardiovascular disease. In particular, individuals who undertook aerobic exercise as their mode for exercise training.

A recent meta-analysis reported that aerobic-based interventions in cardiovascular disease management were correlated with a statistically significant reduction in hospitalisation rates and improved quality of life. Exercise should be individualised to the individual and monitored at all times, to ensure the patient’s safety. Individuals should aim for 30minutes of moderate-intensity aerobic exercise, 5 times per day (This can be broken up into segments of no less than 10minutes). Resistance training should aim to be performed at least 2 days per week at moderate intensity (1 set of 8-12 repetitions).  These targets may be overwhelming for many sedentary individuals with cardiovascular disease. 

An Exercise Physiologist can appropriately tailor the program and use progressive overload to gradually build-up to the exercise guidelines.  An Exercise Physiologist can also provide information to the other practitioners involved in the patients care. This could involve updating the dietician of the patient’s caloric expenditure and providing information to the general practitioner of the patient’s overall health such as blood pressure readings, blood glucose readings and aerobic fitness scores. This is an example of communication within a multidisciplinary approach.

OPTIMUM HEALTH SOLUTIONS

This can be reflected in Optimum Health Solutions multidisciplinary team that boasts a wide range of allied health professionals. Optimum Health Solutions provides services to a range of health conditions including cardiovascular disease management. Patients can attend Optimum Health Solutions as part of their outpatient care and have a multidisciplinary team assist with their healthcare needs. This means that patients can have the benefits of a multidisciplinary approach all in the one vicinity. As a result, the patient can reap the benefits of a multidisciplinary approach provided to them to ensure the best outcome.

REFERENCES

Cowan, M.J. Hallmarks of quality: generating and using knowledge. Communicating Nursing Research. 2004; 37 (1): 3-12.

com. 2020. Multidisciplinary Healthcare. [online] Available at: <https://www.interhospi.com/fileadmin/artimg/multidisciplinary-healthcare.pdf> [Accessed 1 October 2020].

Jennings, C. and Astin, F., 2017. A multidisciplinary approach to prevention. European journal of preventive cardiology, 24(3_suppl), pp.77-87.

Ledwidge M. et al. Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care ? Eur J Heart Fail. 2003 Jun; 5 (3): 381-9

Ponikowski, P., Voors, A.A., Anker, S.D., Bueno, H., Cleland, J.G., Coats, A.J., Falk, V., Gonzalez-Juanatey, J.R., Harjola, V.P., Jankowska, E.A. and Jessup, M., 2016. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal, 37(27), pp.2129-2200.

Riley, J.P. and Masters, J., 2016. Practical multidisciplinary approaches to heart failure management for improved patient outcome. European Heart Journal Supplements, 18(suppl_G), pp.G43-G52.

Sainsbury, R. et al. Survival from breast cancer. Influence of clinician workload and patterns of treatment on outcome. Lancet. 1995 ; 345 : 1265-1270.

Taylor Rssagar, VADavies, EJBriscoe, SCoats, AJDalal, HLough, Frees KSingh S. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2014;Cd003331.

int. 2020. WHO | About Cardiovascular Diseases. [online] Available at: <https://www.who.int/cardiovascular_diseases/about_cvd/en/> [Accessed 1 October 2020].

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