Cardiology

Six consultants provide a comprehensive Cardiology service including a joint post with Liverpool Heart and Chest Hospital with a specialist interest in interventional cardiology. The speciality has seen the development of care pathways for patients with Myocardial Infarction and management guidelines for Heart Failure, Acute Coronary Syndromes, Stable Angina and Atrial Fibrillation.

We have a purpose built cardiac catheter laboratory that has been open since January 2006. The service offered by the Catheter Lab is provided by both Chester and Wrexham Consultant Cardiologists, providing diagnostic angiography, pacemaker implants and cardioversions.

A well-established Cardiac Rehabilitation service reviews patients post surgery and post Myocardial Infarction. This is run in conjunction with local PCTs to ensure continuity of care.

The department is further supported by a team of Cardiac Nurse Specialists, as well as two Clinical Assistants who assist with the Outpatient Clinics.

Cardiac Rehab

The Countess of Chester Hospital and Community Care Western Cheshire PCT offers a range of clinical and community services to over 250,000 patients in Chester, Ellemsere Port and Neston and rural West Cheshire.

Cardiac Rehabilitation (CR) at the Countess of Chester Hospital (COCH) and Western Cheshire Primary Care Trust (WCPCT) delivers Phases 1-3 (and supports 4 via 'clinical drop in') on site at COCH as an inpatient service and then delivers Phase 2 on site at COCH and a local community hospital. Phase 3 (individual exercise prescription, group based exercise and education sessions) is routinely delivered on site at the hospital in addition to two local community site (University of Chester Fitness Suite) and Ellemsere Port Fire Station Community Gym) for greater equity of access and increased patient choice.

Meeting the needs of the community:

Clinical Inclusion (recent diagnosis):

 

• Myocardial infarction/heart attack (STEMI and NSTEMI)
• Cardiac revascularisation (balloon angioplasty with or without cardiac stents)
• Cardiac surgery (coronary artery bypass graft including heart valve surgery)
• Heart failure (ischaemic and non-ischaemic) EF<40%
• Heart transplantation

All of the above who also have heart devices ICD (implantable cardioverter defibrillator or Pacemakers.

Social inclusion:

• Female only sessions offered at all our community sites;
• Low impact exercise groups for the elderly and co-morbid, include chair based exercise classes and group based circuits;
• Higher impact groups (younger physically fit men/women, possibly due to return to work);
• Education only sessions (partners and carers are invited to attend all the above Phases 1-3).

Based at the Countess of Chester Hospital and community sites across western Cheshire, we provide a multidisciplinary service for the care of patients who have been diagnosed with a heart attack and or undergone cardiac surgery or have a new diagnosis of heart failure.

Cardiac rehabilitation includes an initial clinical assessment following a recent admission and covers basic measures including review of symptoms, medications, ECG, blood pressure, recovery and long term plan of care, return to work and notably risk factor modification and lifestyle factors. Onward referral to specialist services can also be made (smoking cessation, anxiety management, erectile dysfunction, community mental health team). Cardiac rehabilitation is now a part of NICE guidance for post MI care and is supported by robust evidence base in the secondary prevention of coronary heart disease.

Cardiac Rehabilitation does offer an additional 12 week exercise and educational programme that is centred on individual needs (low impact exercise, education only, patient returning to work, high impact exercise if required does offer female only classes). Cardiac nurses, rehab specialist, physiotherapists and exercise physiologists who specialise in exercise based rehab form part of a multidisciplinary team to delivery a wide variety of components of the service.

Educational components include: cardiac medications, stress management, physical activity, weight management, risk factors, cardiology, and basic life support. An individual plan of care is made with a clinical member of staff to choose a programme that is most suited to the individual.

Follow up in cardiac rehabilitation starts as an inpatient if you have had a heart attack and were treated as an at the Countess of Chester Hospital. For any patients who are treated off site (such as Liverpool Heart and Chest Hospital, or out of area) the programme starts when you are discharged home. All patients should be advised to contact their local service as soon as they are discharged home. Alternatively, contact will be made by the Cardiac Rehab Team as soon as possible thereafter.

We provide a comprehensive inpatient and outpatient cardiac rehabilitation service.

Phase 1: Initial ward based (or early phone call following immediate discharge from Liverpool Heart and Chest Hospital/ other tertiary Centre) assessment informs both the patient and clinicians of the most appropriate programme of care, which includes symptom management and education for patients following their heart attack/ and or heart surgery. This is aimed as an early point of contact for follow up early after discharge from hospital. A variety of patient based literature is available.

Phase 2 is clinical assessment via an outpatient appointment and covers symptom management, understanding the diagnosis, recovery, education, goal setting and planning a suitable follow up programme of longer-term care. Patients are then given the option to carry on to the 12-week exercise and education programme.These assessments are on site in the Longhouse at Countess of Chester Hospital or at Ellesmere Port Hospital.

Phase 3 Up to 12- weeks cardiac rehabilitation programme of exercise, education, and risk factor management. Sessions are delivered at both hospital and local community sites (University of Chester Fitness Suite and Ellesmere Port Fire Station) across Cheshire and Wirral Partnership Trust. The exercise sessions are clinically supervised and an exercise programme is individually prescribed based on clinical need.The exercise can be very low impact up to high intensity and vigorous exercise if required.

Exercise sessions can include:

• Chair based exercise/mobility
• Group based circuits (low impact)
• Women only sessions
• Higher impact exercise

Clinical /exercise specialists can guide patients when to return to work, and if appropriate instruct on physical exercise and return to usual sports participation.

Further referrals can be made if required to smoking cessation, community mental health, community matrons, and sexual health.

Access

We receive referrals:

• As an inpatient at Countess of Chester Hospital following diagnosis of a heart attack
• From tertiary surgical centres, with patients who have had cardiac intervention / surgery (such as Broadgreen Hospital, The Royal, Wythenshawe Hospital) (coronary artery bypass grafts including valve surgery, primary angioplasty, angioplasty or stents, heart devices such as biventricular pacemakers and ICDs)
• Local/regional and national rehabilitation centres with confirmed diagnosis of heart attack/cardiac surgery or cardiac revascularisation (coronary artery bypass, primary angioplasty, angioplasty or stents); devices such as ICDs and Biventricular pacemakers
• From GPs who have confirmed a recent diagnosis of heart attack/cardiac surgery or cardiac revascularisation (same as above)
• From consultant cardiologists and heart failure specialist nurses who refer patients with new onset heart failure (left ventricular systolic dysfunction or a confirmed ejection fraction <40%)
• Self referral from individuals, but will require recent confirmation from a medical practitioner of any of the above diagnoses.

Where and when sessions are delivered

Phase 1 Inpatient Cardiac Rehabilitationat Countess of Chester Hospital. Ward visits are Monday, Wednesday, Thursday and Friday, 9.00am - 12.00pm.

Phase 2 Clinical Assessments at Countess of Chester Hospital and Ellesmere Port Hospital (by clinical appointments).

Phase 3 Exercise and Educational Sessions at the University of Chester Fitness Suite on Tuesday (women specific), Wednesday, Thursday, Friday (Heart Failure), 9.00am -12.30pm.

Phase 3 Exercise and Educational Sessions There is an 'Outreach Gym' at Ellesmere Port Fire Station on Monday, Wednesday (women specific), and Thursday afternoon 2.00-5.00pm.

Many more classes run in the community for patients who finish cardiac rehabilitation and want to carry on their efforts well supported in the community and by Cheshire and Wirral Partnership Trust via Health Promotion initiatives.

Contact information

Sophie McIntosh- Cardiac Rehabilitation Specialist

01244365662 (Main reception)

01244365192 (Direct Dial)

E Mail : sophie.mcintosh@nhs.net