Questions and Answers

Q1. What is the Heart Manual Programme?

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  25th  year, continues to provide an evidence based approach, assisting the recovery of 14,000 patients annually in the UK and abroad.

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.

All resources are updated regularly and in line with any new guidance. Both 6 week programmes are facilitated by specially trained clinicians. Patients are followed up at home by telephone, home visit or clinic appointment at intervals agreed with the patient and are dependent on need.

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'. The digital resource is now available to order and is facilitated in a similar way to the hard copy Manuals. 

On an international level the programme is used in Canada and the Cayman Islands . The Heart Manual department has since collaborated with external partners to produce a Stroke Workbook, Heart Cycle (tele-medicine) programme in Europe, the Heart Failure Manual and Cancer Manual.

Q2. Can the Heart Manual be used as an alternative to hospital based cardiac rehabilitation?

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

The programme is a simple to use  tool offering patients and their families a choice of cardiac rehabilitation programme delivery.  It can be used in conjunction with a hospital based programme or as a stand- alone programme.

Q3. 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.  

Key factors with the Heart Manual Programme: 

  • ·   body of evidence over 25 years
  • ·   only home based cardiac rehabilitation programme with     three RCTs
  • ·   belongs to a public body (NHS)
  • ·   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. 

Q4. How can the HM programmes support self-management?  

The Heart Manual as a supported self-management programme addresses 3 main areas: understanding the condition and treatments and addressing cardiac misconceptions, individual goal-setting and exercise/walking plan and psychosocial issues/relaxation techniques.

The overall aim is that the patient will become enabled to understand and manage the risk factors they believe caused the heart attack and by gradually resuming activities regain their confidence. The support and knowledge of the HM facilitator is important to ensure the best outcomes for the patient. 

Q5. Who are the programmes suitable for?

This is discussed in 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 is a clinical one and requires assessment of the patient and their individual needs/ circumstances /wishes and consideration of other co-morbidity. It is important to note, however, that the HM is flexible and can be tailored to suit the needs of the majority of  individuals and their families.

Q6. Many individuals return to work before the end of the 6 week programme. Can this programme be used when they are back at work?

Yes. The programme is built around a 6 week framework, 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 may 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. What about helping the family/carer?

At this anxious time, partners and carers often feel the need for information and reassurance. It is ideal if the family can be present when the HM is facilitated to allow carers to ask questions too and understand the purpose of the programme. A CD especially for partners and carers can be helpful to answer questions, and involving them can be very beneficial for the patient.. Many family members benefit from reading the HM and enjoy the relaxation and walking programme too. The resource, and the facilitator, can help to allay anxiety and encourage partners in their supporting role at home.

Q8.  How do we get our patients started with the Heart manual?

In the first instance get in touch with us at heart.manual@nhslothian.scot.nhs.uk 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. We only supply the Heart Manual once a ‘facilitator’ has been trained. This person, usually nurses or physios will receive a two day training course followed by  the first batch of Manuals.  Training packages/dates for individuals or groups can be discussed with a member of our team.

Q9. 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 All income received goes towards maintaining, improving and evolving these self funded resources. 

Q10. 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. Our staff can be contacted by phone or e-mail (as above). Facilitators also receive a personal log-in for our online facilitator  training area which contains resources and updates to continue supporting you.

Update training days can also be arranged for a small fee: this can be helpful for facilitators who have trained a while ago and would like to be updated on current practice, or for those who may not have used the HM for a while.

 

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