Questions and Answers

Q1. What is the Heart Manual Pr​ogramme

The Heart Manual is part of a range of services provided by NHS Lothian.

The Heart Manual Programme (NHS Lothian) is the UK's leading home-based supported self management programme for individuals' recovering from acute Myocardial Infarction. The service now in its 24th year, continues to provide an evidence based approach, assisting the recovery of 14,000 patients annually in the UK and abroad. The Post Myocardial edition was updated in 2016.

The Heart Manual Revascularisation edition for patients who have had coronary artery bypass surgery (CABG), or angioplasty (PTCA/PCI) was launched by NHS Lothian in 2007 following a successful 4 year RCT with the University of Birmingham. This edition was updated 2017.

Both programmes are facilitated by specially trained clinicians-to enable patients’ consensus, understanding and management of their condition. Please take a look at the Heart Manual Evidence page.

Digital Version - The Digital Heart Manual (Post MI edition and Revascularisation) has been reviewed by cardiac rehabilitation patient 'graduates' and clinical staff in the evaluation that ended May 2015.  The response to the Digital Heart Manual has been very positive with common themes being 'easy to use' and 'a great resource'.  

On an international level the programme is used in Canada, translated into Italian and Dutch. Its approach has been used to support the development of a stroke workbook, initially funded by the Scottish Government and CHSS. Also in 2009, Philips electronics invited the Heart Manual to apply the approach to a heart failure telemedicine programme within Europe.

Q2. The evidence over 22 years ?

See the Evidence.

Q3. How can the HM programmes help individual patients?

The Heart Manual as a supported self-management programme addresses many different treatment approaches, include:-

  1. Cardiac misconceptions
  2. Pacing and goal-setting
  3. Relaxation
  4. Exercise and diet
  5. Risk factor education
  6. Behavioural management
  7. Medication and interventions
  8. Relationships

The overall aim is that the patient will become enabled to understand the factors they believe caused the heart attack and therefore regain their confidence.

Q4. Who are the programmes suitable for?

This is discussed in much detail during the 2 day facilitator training, but briefly it is suitable for many patients who have had CHD, Angina, an MI, PCI or/and CABG. The decision will be a clinical one, however as it is individually facilitated, and each patient is individually assessed the programme can be tailored to meet the needs of most.

Q5. Can the Heart Manual be used as an alternative choice to hospital based cardiac rehabilitation?

Yes, comparison studies among low risk patients after myocardial infarction and revascularization have shown the Heart Manual to be equally effective as hospital based rehabilitation (see Evidence page).

The programme is a simply used tool offering patients and their families a choice of cardiac rehabilitation programme delivery.  It can be used in conjunction with a hospital based programme. It also helps free clinical in hospital/group time for patients with more complicated conditions.

Q6. Many individuals return to work within 2 - 3 weeks after their event, can this programme be used when they are back at work?

Yes indeed.  The programme is built around a 6 week frame, so that a structure is there to support each patient and their recovery.  If individuals return to work earlier than 6 weeks, then of course they can continue their programme, by working towards the healthier lifestyles and goals they are aiming for.  The newly launched digital format will suit some individuals better.

Any recovery or healthy living programme needs to fit around an individual’s life.  If something starts to feel like it is "extra" to do, it is highly unlikely that individuals will complete or maintain the goals that they have set.  The wealth of evidence based information in the resource is also there to go back to should any blips occur along the way hence supporting many ( and their families) to successfully self manage at home.


Q7. OK, I’m interested; so how do patients receive it?

Firstly please contact one of the team to discuss the many options to accommodate your resources/needs.

We only supply the Heart Manual once a ‘facilitator’ has been trained. This person, usually nurses, physios and occupational nurses receive a two day training course with the first batch of Manuals. Special questionnaires are supplied, which guide the facilitator and patient through the programme and help to identify problems that may arise. They also act as a check on recovery. The facilitator is shown how to help the patient cope with these problems. This person, who can be any member of the health team, contacts the patient at set intervals during the programme. This can be by phone, in group meetings or home visits as appropriate to individual area’s resources.

Q8. How much does this all cost?

The Heart Manual programme/s are provided free of charge to patients after their clinical assessment.

NHS institutions, private hospitals or insurance companies wishing to use it with patients should contact our NHS office (0131 537 9137) to discuss our reasonable costs which can also be found in Training and Packages.  All income received goes towards maintaining, improving and evolving these self funded resources. 

It is important to note that the Heart Manual is a highly evidenced, effective resource which to date has met the needs of approximately 300,000 plus patients. ​​

Q9. How frequently are the heart manual programmes reviewed and updated and what is the process?

The programmes along with the facilitator training are usually updated every 2 years. This work is core to the service's remit in order to provide the most current resource possible to NHS providers/patients.

This process itself includes literature searches/reviews; mapping of content against the relevant national and international guidelines; and collaboration with professionals in this clinical/academic area. Patient involvement is also core to the process as is a review of the best media formats for delivery/acceptability at that given time.

Q10. What about helping the family/carer?

Hospital visiting times are often very busy and partners may come away with a mountain of information and do not know where to begin. Some will not want to ‘bother’ medical staff. Even if they do ask for or receive information they may be too worried to take much of it in. For this reason there is a special CD for the partner or carer. If possible this should be given to them before the patient’s discharge. It provides the answers that we know are most commonly sought and it also encourages the family to join in with the Manual. Many do take up the relaxation and exercise programme, and report that it helps them deal with the stress of what has happened. It is recommended they read the manual also which can help allay some of the anxiety.  Reading the Manual can help to reduce their anxiety too. Partners also have their own needs – many blame themselves for what has happened. They are unsure how to treat the patient when they become irritable or tearful, as many do following discharge. They may need encouragement to attend to their own needs and to be helped to feel confident enough to allow the patient to exercise or spend time alone.

​Q11. How can I encourage our hospital/my manager to use the Heart Manual programme?

In the first instance get in touch with us at or telephone on 0131 537 9137. We will be able to help you with what is the best way forward to suit your specific needs. 

With over 23 years experience, a database in excess of 4,000 trained facilitators, development of the programme UK and globally, our NHS team (clinical and administrative) are there to support you all the way.

Q12. After a facilitator is trained what ongoing support do you offer and how much does this cost?

Once you become a facilitator this NHS department is here to offer ongoing support free of charge. We will do our upmost to address any of the issues that you have.

Update days can also be arranged (small fee) for those who may have trained a while back to become a facilitator and have not used the programme for a while.

Q13. How do the Heart Manual programmes compare to other cardiac rehabilitation self management/home based packages on offer?

There are indeed a growing number of packages now available on the open market, many of which offer similar ingredients. 

The key factors with the Heart Manual Programme are:
  • its body of evidence over 22 years
  • it is the only home based cardiac rehabilitation programme with three RCTs
  • it belongs to a public body (NHS)
  • its sustainability
  • the numbers of patients and families it has supported over the years 
  • its evolution into other conditions and languages
Other characteristics are its low cost (not for profit profile) and the ongoing support from NHS clinicians, and support staff, to colleagues facilitating it.

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