Heart Failure
The benefits of Cardiac Rehabilitation programmes for people with heart failure have been well established. They have proven to "reduce cardiovascular mortality, reduce hospital admissions, improve exercise capacity and health-related quality of life"
(Scottish Collegiate Guidelines Network, 2017)
Who is it for?
For those with the diagnosis of:
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Heart Failure
A diagnosis of heart failure will be confirmed by a test which will usually be requested by your cardiologist. This will include:
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Echocardiogram - this is an ultrasound scan of the heart. This scan will be conducted so that your consultant can understand the full extend of your heart's function. The function of the left main pumping chamber of the heart (left ventricle) is expressed as an ejection fraction (or EF number). A normal EF is usually between 50-75%. If the EF is less than 50%, this may be a sign of heart failure. You can read more about echocardiograms here.
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Blood Test - a specific marker or protein in your blood (known as Blood Natriuretic Peptide) may contribute to a diagnosis of heart failure. You can read more about BNP and other blood tests here.
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Cardiac MRI - this is very detailed assessment of the heart muscle and the extent to which the heart has been affected. You can find out more about Cardiac MRIs here.
The most common causes of heart failure is ischaemia, a restricted or inadequate blood supply to the heart muscle which can manifest itself as a heart attack. Other things that can cause heart failure include arrhythmias, infections and excessive alcohol consumption. Sometimes the cause may be unknown.
When can I start Cardiac Rehabilitation?
Starting cardiac rehabilitation will depend on your location on what is known as the "heart failure pathway" - an indicator of a propensity for, or probability of heart failure (or where you are in terms of your heart failure diagnosis).
How does it work?
You can refer yourself by simply contacting us. We can then gather the relevant information. Alternatively, you can ask your GP or healthcare professional to refer you. Frequently, your Cardiologist or Nurse Specialist will refer you directly.
Once you have been referred to Heartsure, a member of the team will contact you directly. You will be asked to provide some basic information to confirm your identity and to give us an indication of your medical history, following which a member of our team will discuss the path to recovery. Some questions that might be asked are:
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Are you symptom free?
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What are your current activity levels?
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Are you complying with your doctors recommendations and taking your medication regularly?
An Initial Assessment will then be booked.
Initial Assessment (IA)
The initial assessment is an individual session with our clinician. This is the first meeting of your rehabilitation programme where our clinician will discuss your diagnosis and what it means for you. Whether you have had a heart attack, or you suffer from Angina or valve disease, our clinician will discuss the treatment you have had and how this benefits you.
During the initial assessment, the clinician will also discuss your medication and your lifestyle to assess if there may be any factors that affect your health. You can use this as an opportunity to ask questions to gain a better understanding of your prescription medication.
After this, our clinician will take some baseline observations to better understand your health, which can include:
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Resting ECG
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Blood Pressure
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Height & Weight (BMI)
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Lung Function
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Heart Rate
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Oxygen Saturations
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Peak flow test
Your clinician will discuss the normal parameters for these observations, and explain what your results mean.
"I see patients diagnosed with heart failure hugely benefit from cardiac rehabilitation - not only physical improvement, buy psychological improvement as they take ownership of their diagnosis"
- Dr. Tapesh Pakrashi, Consultant Cardiologist and Heart Failure Lead
Lastly, an exercise assessment will help us to identify any mobility problems that you may have. A simple walking test will be performed to assess your heart's response to exercise. We will attach a small monitor to record your heart rate and you will become aquatinted with a medically supervised exercise circuit. Here you will learn the correct way to exercise for your heart. Using heart rate monitors and other exercise assessment tools, we will aim to gain an understanding of the level of exercise you need to achieve.
A routine session will consist of:
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A simple warm-up, which will include stretching exercises
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A 6-8 station exercise circuit specifically designed for cardiac patients
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An extended cool down period with progressive stretches
Supporting Equipment - We can offer a Polar activity device (a heart rate monitor and activity tracker). This will allow our clinicians to analyse your activity, track your steps, monitor your sleep and record your heart rate during exercise. We will then devise an action plan and some personal short-and long-term goals. You can find out more about the equipment we offer and prices below under 'covering your care'
Following the Initial Assessment - A comprehensive report and clinic letter, which will include your personal goals and action plan, will be sent to your cardiologist, surgeon, referring clinician or GP.
One-to-One Exercise Sessions - Weekly / regular sessions – with your clinician.
At the start of each weekly or regular session you will have a health check-up which will include your Baseline Observations. There will then be an opportunity to discuss your progress since the last session. We will review any on-going symptoms and identify any problems and successes. If you are using a Polar activity device (see example below), the data collected can be analysed and feedback given. If for any reason your goals have not been achieved, we will review the reasons and work together to get you back on track. Whilst continuing to work with your clinician on the medically supervised exercise circuit, the clinician can adjust and adapt the circuit to suit your needs. At the end of each session we will summarise your achievements and set a plan for the time until your next session.
Discharge / Review Meeting - After a defined period of time from the start of your programme, there will be an appointment with your clinician and a review of your goals. New goals and future action plans will be set. You will then repeat the ‘Exercise Test’ and assess any improvements made in your fitness levels. A summary of goals will be discussed, with new challenges set for any which haven’t yet been reached. An updated progress report will be sent to your cardiologist / surgeon / referring person and GP.
Covering your Care:
How long will my programme last?
Cases and rehabilitation programmes are assessed on an individual basis. Your clinician will suggest the number of sessions you need. Please note, NHS training programmes are, on average, 8 weeks in duration (excluding the initial assessment and discharge session)
Self-Funding:
Initial Assessment - £250.00
One-to-One Exercise Session - £100.00
Discharge / Review Meeting - £150.00
Appointments are usually 75 minutes long, with the exception of the Initial Assessment which lasts around 2 hours.
Health Insurance:
While some insurance companies do cover our programmes, most do not cover the full course of treatment. Please confirm this with your insurance provider and policy prior to commencing rehabilitation sessions, or contact a member of the team to discuss this further.
For more information about our prices and plans, please find our Rehabilitation fee schedule here.