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NHS Long Term Plan 2021 - Partner Profile - NHS Leicester -Activate Your Heart ®

Updated: Nov 25, 2021

Cardiac Rehabilitation (CR) is an evidence-based intervention developed (by a multidisciplinary team) that has been designed and delivered to people after a cardiac event. It has been proven to be clinically and cost effective for reducing premature death and improving physical, psychosocial and health-related quality of life outcomes. Although the benefits of Cardiac Rehabilitation (CR) are well established (Domain 1 of the NHS Outcomes Framework), uptake remains disappointingly low at 50% (National Audit Cardiac Rehabilitation (NACR report, 2019). The NACR report acknowledged that ‘more should be done to support these options as part of the menu of approaches offered by programmes, as this can only help to improve uptake and adherence to CR’.

The ACTIVATE YOUR HEART ® (AYH) is an online self-management Cardiac Rehabilitation (CR) programme that has been designed by Cardiac Rehabilitation specialists and patients at the University Hospitals of Leicester NHS Trust. The web-based CR programme was developed as an alternative approach to providing support to patients with the diagnosis of Coronary Heart Disease (CHD) but with remote supervision. Our initial development was supported by a Shine Innovation award from the Health Foundation in 2010.

AYH is documented in the National Institute for Health and Care Excellence (NICE) website; https://www.nice.org.uk/sharedlearning/maximising-access-to-a-cardiac-rehabilitation-service-through-service-redesign-and-an-innovative-web-based-approach-activateyourheart and highlighted as an innovation in the British Heart Foundation (BHF) ‘Turn back the tide’ Report (2018).

How has ACTIVATE YOUR HEART ® improved outcomes for the NHS and patients?

Locally we have analysed the data from the web-based CR programme and the results and feedback have been overwhelmingly positive:

  • Patients have been offered more choice. When asked, 65% of people who completed ACTIVATE YOUR HEART ® said they would not have attended an out-patient CR programme

  • There has been an improvement in patients progressing onto their individual assessment

  • Staff time has been more effectively and efficiently used and over a four week period has released 15 hours band 6 CR professional time

  • Local uptake to the service has improved – 58% which is 8% above the national average (data taken pre-covid)

  • The current cost of ACTIVATE YOUR HEART ® programme is in the region of £330 per patient including initial first patient assessment and exit/final patient assessment. This compares with £700 for a conventional approach

ACTIVATE YOUR HEART ® has enabled our service to deliver education much earlier in the patients CR pathway which in turn ensures that patients are better informed about their cardiac condition and how to cope. Patients also have the flexibility of accessing the information at a time that suits them. Using patient testimonials and consultant endorsements positively encourage patients to attend their CR assessments and subsequent programme tailored to their needs and ability. ACTIVATE YOUR HEART ® is now well established and embedded within existing range of options available to our patients.

What has been your greatest achievement to date? And were there any measurable outcomes that accompanied this achievement?

We have published academic papers which have analysed both qualitative and quantitative data over the last few years.

Published Research:

  • Evaluating the Interactive Web-Based Program, Activate Your Heart, for Cardiac Rehabilitation Patients: A Pilot Study. Brough C, Boyce S, Houchen-Wolloff L, Sewell L, Singh S. J Med Internet Res 2014;16(10):e242 URL: http://www.jmir.org/2014/10/e242/ doi:10.2196/jmir.3027

  • Exploring the experience of using a web-based cardiac rehabilitation programme in a primary care angina population: a qualitative study. Reena Devi, Christine Carpenter, John Powell, Sally Singh. International Journal of Therapy and Rehabilitation | Vol. 21 | No. 9 | pp 434–440

  • A Web-Based Program Improves Physical Activity Outcomes in a Primary Care Angina Population: Randomized Controlled Trial, Devi R, Powell J, Singh S; J Med Internet Res 2014;16(9):e186, URL: http://www.jmir.org/2014/9/e186, DOI: 10.2196/jmir.3340, PMID: 25217464, PMCID: 4180351

  • A Web-Based Cardiac REhabilitatioN Alternative for Those Declining or Dropping Out Of Conventional Rehabilitation: The WREN Feasibility Study. Two site blinded RCT. NIHR RfpB funded study. Houchen-Wolloff L, et al. Open Heart 2018;5e000860. doi:10.1136/openhrt-2018-000860

How many organisations/clients currently utilise the service/solution across the UK?

During the Covid pandemic we offered ACTIVATE YOUR HEART ® for free to Cardiac Rehabilitation professionals across the U.K for 4 months. The senior CR team trained 84 CR teams during the 1st wave and 54 teams completed the 4 months trial between April-October), some teams started the trial later in the 4 month period. 92% found that ACTIVATE YOUR HEART ® was user-friendly.

We have currently 6 teams from across the UK utilising the programme and many more enquiries since the start of the pandemic.

Is there anything you would like to make delegates aware of ahead of the NHS Long Term Plan 2020 conference on 30th November?

Currently we are working alongside our web developers HARK2 to update our current Cardiac and Pulmonary Rehabilitation web-based programmes - ACTIVATE YOUR HEART ® and SPACE for COPD ® to develop a new app based self-management rehabilitation programme that will incorporate a broader range of cardiac and respiratory conditions, which will also include content for arrhythmia patients.

What do you feel are the key points delegates need to digest when considering a partnership with NHS Leicester?

ACTIVATE YOUR HEART ® web-based CR programme offers:

  • An alternative approach to delivering Cardiac Rehabilitation

  • Patients have the flexibility in accessing information anytime in the day/night

  • Increase access to CR in line with the NHS Long Term Plan milestones

  • Improve patient choice

  • Individually tailored programme

  • Statically significant improvements in physical capacity, quality of life and mood in comparison with traditional CR programmes

  • High level of patient engagement within the web-based programme

  • Patients have access to information for up to 12 months

  • Highlighted in national reports (NICE, BHF)

  • Recorded as part of the National Audit of Cardiac Rehabilitation (NACR) CR programme as a digital option for patients

  • Addresses the British Association of Cardiovascular Prevention and Rehabilitation core components of CR

  • Releases CR professionals time for more complex patients

If you would like to find out more information regarding the ACTIVATE YOUR HEART ® web-based CR programme please contact us via activateyourheart@uhl-tr.nhs.uk

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