Photo above: Scarborough and Rouge Hospital (SRH) cardiologist Dr. Joe Ricci (centre) with research colleagues, Dr. Stephanie Frisbee and Dr. Neville Suskin, at the American Heart Association’s QCOR 2018 Conference, where they presented their findings from a study on SRH’s regional cardiovascular rehabilitation service.

New research on the success of Scarborough and Rouge Hospital’s (SRH) regional cardiovascular rehabilitation service was shared internationally at the American Heart Association’s QCOR 2018 Conference in Washington, DC., held April 6 to 7.

A research collaborative led by SRH cardiologist Dr. Joe Ricci, who is the medical manager for the regional service, was accepted to present three abstracts at QCOR 2018. The conference was attended by Dr. Ricci and collaborative members Dr. Neville Suskin, medical director of the cardiac rehab program at St. Joseph’s Health Care and associate professor at Western University, and Dr. Stephanie Frisbee, professor of epidemiology at Western University. Their oral and poster presentations highlighted findings from an Applied Health Outcomes Related Quality (AHRQ) study and shed new light on the merits of our cardiovascular rehab program, which is unique in North America as a regionally-managed, community-based service.

“We are pleased to be able to share the achievements of our highly successful regional program with the American Heart Association,” said Dr. Ricci. “Our community-based system of care is not only improving population health, it is also doing it in way that is cost-effective and that can be modeled by other jurisdictions and health-care providers. It is a privilege to have findings on our clinical activity published at a meeting of this significance.

The AHRQ study was designed to better understand the impact of patients participating in our rehab program, which is funded by the Central East Local Health Integration Network (LHIN) and is currently offered at 14 community sites throughout the region. In addition to the Central East LHIN, the service is also delivered collaboratively with local partner hospitals, municipalities, and community centres. In 2017-18, more than 3,700 patients participated in the program, making it the largest cardiovascular rehabilitation service in Canada.

The study was conducted over a period of 18 months and followed more than 11,000 patients who were referred to the program. Data from the study showed overwhelmingly the program is helping to improve health for cardiovascular patients and break down barriers to access.

Key observations from the study include:

  • The mortality rates for patients who completed the program was just 0.7 per cent, compared to 11.8 per cent for patients who did not start the program.
  • The rates for hospitalizations and emergency department visits for a cardiac reason were statistically lower for those who completed the program at 9.7 per cent and 3.3 per cent, respectively, versus the rates for a comparison Central East LHIN group at 14.4 per cent and 4.2 per cent.
  • The enrollment rate for patients referred to the program was over 50 per cent, which is higher than the 20 per cent enrollment rate for cardiovascular rehabilitation across Canada and 22 per cent rate in Ontario. Of the group who enrolled, 67 per cent completed the program.
  • The completion rates were nearly identical for men and women, and for those referred to the program while in hospital and those referred from the community. The income of patients was also not associated with the completion rate, and older patients were found to be more likely to complete the program than younger patients.

“This performance reflects the impact of delivering cardiovascular rehabilitation as regional system and how this can markedly improve the effectiveness of the service,” said Dr. Frisbee.

“There are many factors underlying what makes our regional program so strong,” added Adam Pierce, program manager for the service, and a member of the research collaborative. “We have standardized the service provided and the patient experience, and we use a hub-and-spoke model to centralize referrals to the program ” but it’s all delivered with a regional team and local partnerships at multiple community sites located 30 minutes from where patients live and work.”

The American Heart Association QCOR conference marks the first time that findings from the study are being published. Abstracts for oral and poster presentations were also accepted to be shared at the XVII international Symposium on Atherosclerosis being held in Toronto in June 2018. Dr. Ricci and the research collaborative members look forward to additional opportunities to present on the study in the coming year.

More about the study

The AHRQ study was conducted through an award by the Ministry of Health and Long-Term Care, and supported by the Institute for Clinical Evaluative Studies. In 2015, a research collaborative was established to analyze data from the study and publish research on the regional program. The collaborative was led by Dr. Ricci and in addition to Dr. Suskin and Dr. Frisbee, included Dr. Saverio Stranges, chair of the department of epidemiology at Western University; and Dr. Ashraf Alazzoni and Dr. Sangit Jolly from McMaster University.

More about SRH’s regional cardiovascular rehabilitation service

The Central East Regional Cardiovascular Rehabilitation Service is a six-month exercise and education program that helps participants to get on track to a heart healthy lifestyle. This service is specially designed for community members with a vascular disease, or who are at high risk for a vascular condition ” with risk factors such as a history of smoking, diabetes, high-blood pressure, high cholesterol, obesity, and an inactive lifestyle.

Thanks to ongoing funding and investment by the Central East LHIN, the regional service has expanded to 14 community and hospital-based sites in Scarborough, Pickering, Ajax, Whitby, Oshawa, Bowmanville, Cobourg, Port Perry, Lindsay, Peterborough, Bobcaygeon, and Campbellford “closer to where patients live and work. All participants are within 30-minutes travel distance of one of these facilities.

Since the launch of the regional program in 2012, the number of patients participating in the program has continued to increase leading to reduced risk of hospitalization and the need for clinical interventions, and an overall improvement in patients’ blood pressure, level of fitness, smoking cessation and quality of life.