LIONS Gate Cardiac Rehab and Cardiometabolic Program staff members have seen it time and time again: the transformative effect their one-to-one approach to rehabilitation has on the North Shore heart patients they serve.
North and West Vancouver residents are referred to the program either following a heart event like an attack or surgery, or by their general practitioner because they have established vascular disease, or are at risk. Program staff, led by medical director Dr. Kevin McLeod, registered nurses and exercise specialists take a hands-on role in helping the patient not only recover, but begin to lead a more active, educated and healthier life, keeping prevention at top of mind.
The public program is made possible through a unique collaborative partnership between Vancouver Coastal Health and the North Vancouver Recreation Commission, with additional support from individuals and program alumni, members of the North Shore Cardiac Rehab Group, who conduct fundraising initiatives. "That's where it's kind of unique," says McLeod. "We really tie in with the rec centres, which most cardiac rehab programs do not. People would have their heart attack, they'd go to cardiac rehab for one to three months and then, 'See ya later.' That doesn't work well. This is a whole lifestyle change so you've got to stick with it long-term. The rec centres in the City and District (of North Vancouver) have really come
on board to help with that."
The Lions Gate Cardiac Rehab and Cardiometabolic Program is based out of McLeod's North Vancouver practice. At the end of the month, due to growth and an interest in offering additional services, the clinic is moving to a larger 6,000-square-foot space at 200-101 West 16th Street.
The program has been offered for the last six years and the team typically serves 300 to 350 people per year. The first step in joining the program is for participants to undergo a full assessment, lasting typically 60 to 90 minutes with involvement from the full team, consisting of McLeod, a nurse and a kinesiologist with training in cardiac rehab. McLeod says they work to assess the patient's overall health as well as determine their current risk level, potentially through doing a bit of exercise on a treadmill or blood work, etc. They also look at the patient's current medications and whether they're being best served by them.
"It sort of can be a bigger picture look at lifestyle," says McLeod, adding the information they gather helps the team custom tailor a plan to improve the patient's overall health.
Some patients, due to the extent of their heart event and recent discharge from hospital, experience a precursor home-based visit prior to their being well enough to go into the office for assessment. A program nurse drops in as many times as is needed, checking up on their health without them having to go to hospital, providing reassurance and answering any questions they have.
Following a patient's assessment, they're asked to complete a three-to four-month supervised group exercise program, either at Lions Gate Hospital for more at-risk patients, or in one of the North Vancouver Recreation Commission centres. The hospital-based exercise classes, seeing health authority and recreation centre staff work side by side, are offered three times a week.
"The real benefit to patients is they feel safe because it's supervised by professionals and trained staff," says Minetaro Narukivan Velzen, an exercise specialist with the program.
In addition to overseeing their workouts, program staff may measure the participants' blood pressures or record anything else of note that should be reported back to McLeod. "What I think is really nice about the classes is that we're a direct link to Kevin," says Monique Bazille, registered nurse and clinical educator and program co-ordinator. Staff can go to him for advice, or else schedule an immediate appointment for the patient if they have concerns. Staff also work to connect patients with any additional community resources that may serve their well-being, like support for smoking cessation, counselling or nutritional information.
The community centre supervised exercise programs, currently offered at Harry Jerome, John Braithwaite, Ron Andrews and Parkgate recreation centres, operate in a similar fashion in terms of approach and staffing. "People I think appreciate: A, the safety of the supervision; and B, that it's dedicated space for them," says Narukivan Velzen, explaining many of their patients are newcomers to gym settings so the program helps remove any barriers or intimidation they may experience.
Upon completion of the exercise program, participants revisit the program office for a final follow-up appointment.
Staff find many of their patients decide to join the recreation centres following completion of their involvement in the program.
The Lions Gate Cardiac Rehab and Cardiometabolic Program is having a positive impact on patients. Staff polled their outcome data after the first and second years of operation and data showed things like cholesterol, blood pressure, weight and fitness had all improved among participants. "All these things are predictive of overall health: How long they'll live, their chance of having a second heart attack," says Naruki-van Velzen. "The changes were very similar to what's already been known to be the effective cardiac rehab. I think the unique thing there is we were able to share that our program is just as effective as any other cardiac rehab program, but we run in a much more efficient cost model because we're utilizing services that are readily available in the community."
There are additional positive outcomes that are difficult to measure, says McLeod. For example, through their involvement in the exercise programs, patients are given an opportunity to connect with their peers and many don't want to leave the program at its duration due to the sense of community they've gained. "They make friends in there, we take people that are maybe in their 70s and 80s who are isolated. Suddenly they're with a group of people and they're exercising. It doesn't really matter to me that they go down and get a doughnut and coffee after exercise. Their whole sense of well-being and health is better and that has a huge impact on outcomes. It's just very difficult to measure that," says McLeod.
The program also offers a free public lecture series, which speaks to their goal of enhancing patient education. "If the patient can really be educated on their chronic disease process, they're way more likely to be compliant, they're way more likely to have a better outcome. (There's) lots of data to support that," says McLeod.
Sessions last for about an hour and they cover topics like how the heart works or vascular disease. Those in attendance are encouraged to ask questions and share experiences.
"They feel more empowered, which is really positive," says McLeod.
The next public lecture, on common cardiac medications, is being held Monday, March 11 at the Lions Gate Hospital auditorium at 9: 30 a.m.
McLeod is proud of the efforts of staff who go above and beyond to make the program a continued success. "They put in these extra hours because you see the positive outcomes," he says.
Patients who stick with their plans, especially beyond the three months, truly reap the benefits - evident in their weight loss, reduced drug dependency and more active lives. "I find when they stick to it, they're just happier all the way around, healthier happier individuals," says Bazille.
"There's huge benefit to them as an individual, to the health care system, to the taxpayer, to society," adds McLeod.
To celebrate their move to a new office, program staff are hosting a competition called The Fittest Physician on the North Shore, April 9. "We're going to have local docs come down and compete in feats of strength," laughs McLeod.
Local doctors are encouraged to register for the contest on the program's website, in hopes of earning bragging rights among their peers.
Additionally, McLeod says they plan to open up the workout space their new office will house to local doctors and staff to use for free during weekday lunch breaks. "We're really going to try to push local docs to look after themselves and also their staff," says McLeod.
"We really want them to also identify with their patients. Sometimes it's hard to get motivated, some times it's hard to find time to do it. They may preach that you have to do it, but get them motivated as well," he adds.
For more information on the Lions Gate Cardiac Rehab and Cardiometabolic Program, visit vancouverhearthealth.com. For costs associated with the program, visit northvanrec.com.