The Mayo Clinic Model: Delivering High Performance Cardiac Rehabilitation in Ireland

Written by Deirdre O’Reilly, President, Irish Association of Cardiac Rehabilitation

Cardiac Rehabilitation (CR) is recognised as an essential component of secondary prevention for patients with cardiovascular disease (CVD). CR enables each patient to recover fully after their cardiac event (e.g. myocardial infarction) and to actively return to everyday life as quickly as possible. This is achieved by providing a wideranging programme of integrated care encompassing individually tailored exercise prescription, education, risk factor modification and psychosocial support.

Modern healthcare increasingly emphasises the need for high performance and value-based care, and in keeping with this the Irish Association of Cardiac Rehabilitation (IACR) continues to promote the highest international standard of care to ensure that patient outcomes are optimised during CR.

Feedback from frontline CR staff has also consistently identified the need for a short, intensive evidence-based training programme to comprehensively educate emerging cardiology nursing staff to deliver this standard of care.

Responding to this need, the IACR in collaboration with Royal College of Surgeons (RCSI) coordinated and delivered an advanced CR training workshop to support the majority of CR centres in Ireland. We successfully partnered with the recognised international leaders of CR delivery - the Mayo Clinic (Rochester, Minnesota) – who travelled to Ireland to deliver a cutting-edge, comprehensive and in-person CR training programme over 3 full days.

Objectives

The overarching goal for the ‘Cardiac Rehabilitation Workshop: Mayo Clinic Model’ was to make a national impact on the quality of CR delivered in Ireland by sharing international best practices with frontline CR nursing staff from every region of the country. This extended to CR programme

development and administration, CR assessment tools and CR outcome measurements.

Key learning objectives were:

1. To identify key components of patient engagement and patient assessment in CR.

2. To develop appropriate and effective individualized treatment plans (ITP) for CR patients.

3. To summarize the rationale and benefits of tracking patient outcomes in CR .

4. To prescribe an appropriate and effective exercise prescription for each patient in CR.

IACR facilitates regular communication with CR colleagues nationally via fortnightly online meetings. Via this forum and a national assessment of CR quality conducted in collaboration with the Irish Heart Foundation (Charles et al., 2021), a training deficit was identified. Additionally, feedback from frontline CR staff directly informed the eventual format of the advanced CR training workshop provided by the Mayo Clinic. IACR explored the possibility of partnering with the Mayo Clinic to meet the educational requirements

of Irish CR providers in 2020, and numerous meetings over the following two years between Mayo Clinic Faculty (Cardiovascular Medicine) and Irish CR experts enabled the final programme format and content to be devised.

Implementation

Support from the RCSI and local cardiologists enabled the training programme to be hosted in the RCSI Education & Research Centre (Beaumont Hospital), and partnership with industry colleagues covered logistical expenses (e.g. travel, accommodation, equipment and subsidised registration fees). Every effort was made to minimise barriers to attendance for participants (e.g. parking fees). As participant feedback had expressed a strong preference for hands-on in person ‘practical’ training’ (in addition to didactic educational sessions), a ‘hybrid’ training programme was developed in partnership with the Mayo Clinic faculty to provide attendees with a combination of engaging presentations outlining cutting-edge science in CR and practical hands-on experience of delivering both inpatient and outpatient CR. Furthermore, this internationally recognised high-performance CR model was adapted specifically for the Irish healthcare setting.

Knowledge and skills acquisition was conducted face to face in both a classroom and CR gym

setting with expert supervision from 8 members of the Mayo Clinic Cardiovascular faculty (Rochester, Minnesota, USA).

Outcomes

The training workshop was held on September 7th-9th with 36 attendees. In addition to full capacity attendance, participants represented 22 of the 34 CR centres (65%) providing outpatient CR programmes nationally. Open-ended participant feedback indicated that this face-to-face ‘practical’ training workshop was highly engaging and well-received by attendees. Formal evaluations completed via the Mayo Clinic IT platform further indicated that 100% of attendees rated the course as ‘excellent’, 100% would recommend the course to their CR colleagues and 100% felt that the educational content matched their current or potential scope of practice.

This exceptional standard of intensive supervised training has bolstered the existing knowledge and skills of Irish CR staff and will ensure that the majority of CR centres nationwide can deliver comprehensive and ‘high performance’ CR in their local settings.

Mayo Clinic Faculty with Conference organising committee and participants