When Georgette Bensimon was discharged from the Jewish General Hospital last February after 12-hour open-heart surgery and a five-week stay, she could barely walk and was despondent.
As someone who used to go to the gym three times a week, the 74-year-old feared she wouldn’t be able to function, even to go grocery shopping, much less exercise as she used to.
“I had never been so weak in all my life,” she recalled in a recent interview. “I had been intubated and was really in a bad state. I was really scared.”
Luckily for her, a friend mentioned she had heard of a cardiac rehabilitation centre that was very effective. Bensimon looked into it and got a referral for the Cardiac Rehabilitation Centre of the CIUSSS West-Central Montréal at Richardson Hospital.
Even luckier for her is the program, launched about six months before the arrival of COVID-19 in March 2020, quickly switched gears to become a hybrid program, offering virtual services to participants in order to keep it going through the pandemic.
Now, almost a year later, she says the results have been incredible.
“Having that kind of support when you’re in such bad shape is amazing,” she said. “They really helped me gain my strength back and now I can do an hour walking on the treadmill. I feel like I got my life back.”
Even in these days of rampant health-care cutbacks by cash-strapped governments, cardiac rehabilitation is considered so effective at preventing repeat cardiac events and even death the Quebec government is fully funding the program so it is offered at no cost to patients.
Before the centre opened in September 2019, people who suffered a major cardiovascular event had few options.
For a time, there was a rehab program known as CHIP (Comprehensive Health Improvement Program) for which patients would have to pay $1,000 to $2,500. There are some other cardiac rehab programs that have some fees as well.
For the most part, patients would be discharged with the hope of seeing a cardiologist in four weeks for a follow-up appointment, but the time could often stretch to eight to 12 weeks, according to Ann Walling, a cardiologist at the Jewish General who is co-medical director of the centre along with Mark Smilovitch of the MUHC.
“Imagine you just had a heart attack and it takes three months to see someone,” Walling said in an interview. “These patients need to be seen a week later. There are immeasurable benefits when you do cardiac rehab, and the sooner you start the better. It is just as important as stenting or cholesterol pills.”
The centre is now offering the first entirely government-funded cardiac rehab program in the province. Geared to serve 350 people a year from the Jewish General, McGill University Health Centre and St. Mary’s Hospital, Lawrence Rudski, the cardiologist overseeing the program, says the plan is to apply for additional funding to increase the capacity and serve more hospitals.
“It costs only $1,400 per person, but it brings a 25-per-cent reduction in re-admission, repeat events, visits to the ER and even mortality,” said Rudski, the chief of cardiology at the Jewish General and head of the Azrieli Heart Centre. “It is extremely cost-effective and the best results happen if you recruit patients sooner after a heart attack or surgery.”
Debbie Kadoch is the program manager and said there was “a gap in the system” before the rehab centre opened.
“Cardiac rehab is well known for its benefits, including the financial benefits on the health-care system,” she said in an interview.
The program provides a multidisciplinary team to help the patient recover by focusing on exercise, education and management of cardiovascular risk factors.
The team includes kinesiologists, occupational therapists, doctors, nurses, a dietician, a psychologist, a physiotherapist and a social worker.
Participants are guided through supervised exercise sessions with kinesiologists in order to gain confidence in their regular activities and to learn what they can do safely.
“By gaining confidence in their activities, it reduces their fear,” said Lisa Masse, one of three kinesiologists on the team at the centre. “Some have never exercised before and they need to learn to integrate it into their lives.”
Walling ensures patients are medically cleared to do the program, and usually the participants will get on the treadmill their very first day for a stress test. They do strength training to compensate for muscle loss.
“We focus on creating an active lifestyle,” Walling said. However, exercise isn’t always the most important factor for the participants, she said. “If they need psychological support, that’s most important. If weight is an issue, the dietician is most important.”
One of the most beneficial services for participants is having a team of experts at their disposal to answer all their questions. Is this pain normal? How do you use nitroglycerin? Is this exercise safe? What can be done about post-heart-attack depression?
“People are so scared,” Walling explained. “You leave the hospital and your arteries have been stented, but your brain is not fixed up.”
Even with the new wave of Omicron and confinement measures, the centre is still offering in-person visits if it’s optimal for the patient’s recovery, said Masse. But participants have been told the centre is recommending virtual visits with all professionals when possible. As happened with the original onset of COVID-19, Kadoch said the team quickly adapted and began offering online group exercise classes and provided virtual patient access to the entire interdisciplinary team.
Masse said there was live-streaming of exercises as well as recorded sessions available any time. This proved to be popular with the participants, especially since many are older and they found it easier not to have to travel to the centre. Therefore, it seems the centre will continue to function as a hybrid program.
Clinical indicators show the results from the hybrid program are equivalent to those of the in-person program, Kadoch said.
To top off this exceptional year for the centre, the program was recognized with an award from the CIUSSS’s Multidisciplinary Council, as well as being featured in a webinar presentation and blog post by the U.S.-based Advisory Board, one of North America’s leading health-care consulting firms.
Despite the stellar results and how much participants like the program, one of the biggest challenges has been getting local doctors to recommend it.
“Whenever you have a culture change, it takes time to learn to do things differently,” Rudski said.
To combat that, over the last few months, they have implemented a discharge summary program that prompts the doctor, asking if the patient should be referred to cardiac rehab or not. The automation has made it a lot more fluid, Rudski said, and has dramatically increased the number of referrals.
Still, there are only 2,500 patients a year in Quebec doing some type of cardiac rehab, whereas there are 25,000 in Ontario. Considering there are 2,000 admissions a year for cardiac events just at the Jewish, Rudski considers it critical to ramp up the program.
“This is a program that truly links the hospital with the community,” he said. “Everybody feels so good about this program — especially the patients.”