Letter promoting the work of the group from
Dr Shahid Junejo MBBS, M.Sc, FRCPI
Consultant Cardiologist & Clinical Lead for Cardiology
City Hospitals Sunderland NHS Trust

To further the application/ funding opportunities

2nd July 2012
Dear Jim & Barry
First of all, we at Sunderland Royal Hospital Cardiac Rehabilitation Department would like to thank you and The Cardiac Support Group for the efforts put in over the last 18 years since it’s inception in 1993. The groups work has been invaluable to the patients, and families, helping with the physical and psychological healing process. We recognise that the group organise a wide range of activities for their members, including regular exercise classes every week as well as social events, walks and excursions and provide support to members and their families who are ill. The group currently has around 230 members and we are proud to be associated with your group as you continue to inspire so many people with your dedication and commitment.

Cardiac rehabilitation is a multidisciplinary and long term approach to improve the recovery from acute cardiac events and to promote long term changes in lifestyle which help to correct adverse cardiac risk factors. It is a process by which patients are restored to, and maintained in, optimal physical, emotional, social, vocational and economic state. Cardiac rehab programmes usualy include exercise training, risk factor modification, education and councelling (physical and psychological). The ultimate aim is to return a person to their full range of activities and reducing levels of anxiety and lack of confidence.

Rehab is usually delivered in the form of a programme suited to the individual patient, in four phases. Phase one begins while the patient is in hospital, followed by phase two in the early discharge period, phase three is mainly based on the physical aspects of the programme leading to phase four and the life long benefits of physical activity and a healthy lifestyle.

Phase four cardiac rehab is concerned with maintaining physical activity and reducing risk factors in the long term, allowing a patient to continue an active and productive life. It refers to the long term maintainance of physical activity and adopting healthier lifestyle changes. Exercise based cardiac rehabilitation trials have shown the greatest benefit is associated with exercising for twelve weeks or longer. It is well recognised that cardiac rehabilitation is beneficial in reducing both mortality and morbidity following an acute myocardial infarction. Ther is also a body of evidence validating the use of structured rehabilitation programmes and support for patients with Heart Failure and post cardiac intervention.

Publication of the National framework in 2000 gave cardiac rehabilitation the recognition as a vital ingredient in the cardiac patient’s recipe for recovery. Despite significant investment and progress in the early and interventional management of acute cardiac presentation such as primary angioplasty, aggressive early medications and elective cardiac surgery many patients continue to have recurrent events because of the failure to address risk factors such as smoking, weight reduction, lack of exercise and other general lifestyle changes. More emphasis is now being placed on the work of the cardiac rehabilitation teams in tackling this problem and the government is recognising the benefits of lifestyle change and promoting rehab by way of new guidelines published in 2010. The ‘Healthy people, Healthy lives’ paper from the Department of Health emphasises the need to encourage the population as a whole towards healthier lifestyle and living choices. This will shift the focus from advising patients and their carers ‘after’ the event to encouraging primary prevention for the general population and endorses the value of such a strategy in reducing the burden of disease and cost of healthcare.

In a recent study published in the British Journal of Cardiology, ref (1) a group of patients were enrolled in a five years community follow up cardiac rehabilitation programme. All of these patients had suffered a heart attack and had been through the hospital based cardiac rehab programme pror to being discharged home. They were split into groups, one group receiving rehab, one group declining rehab and another not offered due to their geographical location. Following the five year review it was found that the group who had declined rehab had a higher cholesterol level, a significant increase in body mass index (pre rehab) and a higher number of smokers. The group declining rehab showed a significant deterioation over the five years in relation to exercise tolerance levels and did less well than those who continued to maintain a healthy approach to exercise and risk factor reduction.

Pooled data from several other studies over the past few years suggest the reduction in mortality of up to 25% when patients are enrolled in an exercise based cardiac rehab programme. A review in ‘Future Cardiology’ published in May 2009 ref (3) highlighted the emphasis on regular physical activity to maintain a healthy heart and reduce mortality.

The evidence supports the continued delivery of robust rehabilitation programmes facilitating the lifestyle changes with risk factor modification necessary to reduce the adverse outcome of Coronary Disease in all it’s forms/presentations. If the benefits of exercise are to be sustained, moderate physical activity should continue long term and for this  exercise equipment is essential to be able to offer the members of the Sunderland Cardiac Support Group the facilities to continue to improve the quality of life and reduce risk. This is where the Cardiac Support Group is essential to our patients long time recovery. Your work has been invaluable to the population as well as the Primary and Secondary care teams and is helping to reduce readmission rates and further clinical events in a high risk population.

We recognise that providing such a validated service to the population requires secure and sufficient funding. The group relies on patients and families donating as well as support from various local and regional funding sources and without funding the group would not be able to continue the good work. Part of these funds are also utilised to ensure that a BACR (British Association of Cardiac Rehabilitation) trained instructor is available to supervise each class and to pay for the premises where these sessions are held.

To ensure that the group continues to function as a valuable adjunct to the overall care of our population in general but to the cardiac patients in particular it is essential that there are adequate funding streams identified. In the current economical climate there is considerable pressure on individuals as well as organisations and the group needs to apply for external funding to support it’s good work.

As the Clinical Lead for Cardiology Services in City Hospitals Sunderland, and the Clinical Lead for Cardiac Reabilitation, and behalf of Kathryn Miller, Cardiac Rehabilitation Sister in CHS, I support your application for funding to continue the good work you have already established. I hope your efforts are successful and I look forward to a continued relationship with the Cardiac Support Group in Sunderland.

Wishing you success in your endeavours.

Dr Shahid Junejo                       Sr. Kathryn Miller
Consultant Cardiologist &           Cardiac Rehabilitation Sister
Clinical Lead for Cardiology        City Hospitals Sunderland
City Hospitals Sunderand

1. Willmer.K (2009) Long term benefits of cardiac rehabilitation: a five year study.
British Journal of Cardiology 2009:16:73-77

2. O’Conner GT (1999)
Overview of randomised controlled trials of rehabilitation with exercise after myocardial infarction.
Circulation 80 234-244

3. Scrutinio D (2009) Future cardiology May 2009 5 (3) :297-314

4. Byberg L (1009) 338:b688

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