I enjoyed reading the article by Dr Hasnain Dalal on his teamês cardiac rehabilitation project, which involved trained practice nurses (•Integrating primary and secondary care cardiac rehab servicesê Guidelines in Practice, November 2002).
I am involved in a cardiac rehab pilot in Watford and Three Rivers PCT. It seemed a shame to limit the opportunities the project offered to one service area, that of practice nurses. Instead, we invited all community nurses to participate, enabling us to offer them training and to draw on their enthusiasm. Health visitors, practice nurses and district nurses are now working together across the PCT to provide a home visit for patients following MI or angioplasty.
All the nurses have appreciated the opportunity to work as an integrated team across the traditional service boundaries. We all hope that the scheme will be transferred into mainstream practice and eventually include long term follow-up.
Alison Wall, Watford and Three Rivers PCT, Hertfordshire
Dr Dalal replies:
In our scheme, practice nurses provide most of the secondary prevention elements of rehabilitation, mainly because CHD registers are practice based and the NSF advocates long-term follow-up of patients in primary care.
The cardiac liaison nurse aims to see all patients surviving a heart attack before hospital discharge. She has a key role in maintaining links with the practice nurses, ensuring that the names of all patients identified are passed to practices for inclusion on the CHD register.
The liaison nurse also visits patients in the community, supporting patients using home-based rehabilitation after a heart attack and those who have undergone revascularisation and need to be followed up by the hospital-based rehabilitation team. Maintaining contact with the hospital-based team has helped to bridge the gap between primary and secondary care.
It is a good idea to involve different groups of primary care nurses. However, the success of the service in the Watford and Three Rivers PCT will depend not so much on the kind of nurses involved but on how well the programme is coordinated. Given the high prevalence of CHD, many more PCTs should give priority to improving their cardiac rehabilitation and secondary prevention services.