Because of cardiac rehabilitation... patients with heart disease learn how to get healthy and stay healthy

A push in London to ensure care for heart attack patients and others with heart disease doesn’t stop once they leave hospital has many more individuals receiving rehabilitation and the guidance they need to stay healthy.

In recent years, the number of referrals to the cardiac rehabilitation and secondary prevention program (CRSP) has nearly doubled and its impact significantly strengthened thanks to various efforts, such as reaching heart patients before they leave hospital, making the referral process to the program easier, and helping patients turn lifestyle changes into lifelong habits.

“To practice innovative cardiac rehabilitation you need an approach with a broad reach and expertise that serves as a resource for hospitals and the region,” says Dr. Neville Suskin, medical director of the program, now located at St. Joseph’s Hospital in London.

Done right, adds the cardiologist, the impact can be tremendous. The CRSP program conducted a study that shows preventing a second (or third) heart attack can result in a 30 per cent savings in health care costs from reduced hospitalizations. “There are few interventions in medicine that can do that.”

Cardiac rehabilitation patient and clinician

The CRSP program is designed for men and women with heart disease who have had a heart attack, angina, angioplasty or heart surgery. An interdisciplinary team provides patients with a medical evaluation, including exercise stress testing, a prescribed exercise program, lifestyle education, psychological services, nutrition counselling, smoking cessation therapy and more.

Instead of waiting for patients to come to the program, London heart patients are now connected with the CRSP before discharge from hospital. They can even begin smoking cessation therapy before they leave hospital.

“We have implemented a strategy in the inpatient setting so that patients are getting the right care and understand the importance of follow-up and risk reduction,” says Dr. Suskin.

About 500 patients are seen each year at St. Joseph’s CRSP program, which also has four satellite sites in Sarnia, Owen Sound, Ingersoll and Chatham. In a unique partnership with the YMCA in London, exercise prescribed by the CRSP team is carried out at the downtown Y, where patients attend supervised exercise sessions and also work out on their own for six months.

“Ultimately, what we want to do is help patients establish and maintain an active lifestyle, gain strength and confidence, and take charge of their health, says Dr. Suskin. “The key is sustainable, behavior change.  As part of that, we want people to become habitual exercisers.”

With a focus on evidenced-based practice and improving outcomes for patients, research is a key component of the program and patients have an opportunity to participate in various trials, adds Dr. Suskin. One landmark project underway is looking at the benefits of the program for people who have had minor strokes. The five-year project could lead to the program being expanded to stroke patients.

 Care for the heart with heart: the career of Dr. Neville Suskin

Dr. Neville SuskinDr. Neville Suskin is playing a vital role in cardiac rehabilitation in Ontario.

He describes himself as stubborn and persistent, attributes that bought him to the opposite side of the earth to fulfill a passion. Dr. Neville Suskin had never been out of South Africa when he landed in the tiny rural town of St. Lawrence, Newfoundland. It was 1986. The medical school graduate had completed his internship and was seeking opportunities that South Africa couldn’t offer.  At the time, Canada didn’t particularly need foreign-trained physicians. Those who came were sent to “to places where Canadian-trained physicians didn’t want to work,” laughs Dr. Suskin, a city boy who had had never seen snow before. In St. Lawrence he practiced family medicine before pushing on, crisscrossing Canada to pursue his training. He became a cardiologist and established London’s Cardiac Rehabilitation and Secondary Prevention Program, now located at St. Joseph’s Hospital. Here, Dr. Suskin, who has helped shape cardiac rehabilitation in Ontario, talks with humour and vision about where he’s been and where goes from here.

Q. Why did you to choose medicine as a career and cardiology as a specialty?
My passion was actually sports medicine. When I was young, I was almost a semi-pro squash player. But alas, I didn’t have enough skill, or dedication, or earning potential, so my then girlfriend (now wife) strongly encouraged me to stick to medicine. In Canada, I ended up in internal medicine by default when my sports medicine job fell through. I discovered that cardiology, particularly cardiac rehabilitation, piqued my interest.  I now had a new passion.

Q. What brought you to London?
Well, it was the only place where I obtained a cardiology residency spot that matched my wife’s. Following cardiology training I did a research fellowship in cardiac rehabilitation and clinical trials in Hamilton and came back to London on faculty at Western University in 1998 with a mandate to start the academic cardiac rehabilitation program.

Q. What are you most passionate about when it comes to your work?
In cardiology, you can treat very sick patients and they can recover almost completely and are in terrific shape afterwards compared to before. That’s what drives me.  It’s also the ability to work in a team and take the best evidence and deploy it into clinical practice across cardiology for the most optimal outcomes.

Q. What is your vision for the Cardiac Rehabilitation and Secondary Prevention Program at St. Joseph’s?
We have to change the way we conventionally think about care. We need to get patients the care they need as close to home as they want.  The main contact for patients should be with their primary care provider, not specialty care. St. Joseph’s should be the nerve centre, the quarterback for cardiac rehabilitation and secondary prevention,  making sure that primary care is able to maintain the highest level of care with our support.

Q. You could likely work anywhere. What keeps you in London?
The program recently moved to St. Joseph’s Hospital and it’s an opportunity we’ve been looking forward to for years. It’s very exciting for us. Our interdisciplinary team is now in close proximity with other researchers at Lawson Health Research Institute, which will facilitate collaborative research that improves care and outcomes for our patients.

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