Porter plans new cardiac rehabilitation services

MIDDLEBURY — Local residents who have experienced a heart attack, heart failure or heart surgery soon won’t have to travel outside Addison County for medical rehabilitation appointments.

Porter Medical Center next spring will begin offering cardiac rehabilitation services at its Middlebury campus, a new service that’s expected to extend lives and offer greater convenience to local patients who must currently drive to Burlington or Rutland to participate in such programming.

Plans call for the new cardiac rehab offering to be located in a 933-square-foot space currently occupied by Porter’s IT division, just inside the front entrance of the main hospital building off South Street. It will be conveniently attached to the office of Porter cardiologist Dr. Gavin Noble. Porter spokesman Ron Hallman said IT personnel will relocate into “more than adequate space” on the third floor of the same building.

The estimated $319,813 cardiac rehab project (which includes the requisite exercise equipment) will be put out to bid in January, leading to an early June launch, according to Hallman.

Cardiac rehab is currently unavailable in Addison County. More than 40 area patients currently travel to Burlington for cardiac rehab services and only 35.5 percent of eligible patients avail themselves of rehab following a heart attack, according to Porter officials.

“It’s a huge deal, in terms of people’s wellbeing, symptoms, exercise tolerance, daily life, stability from falls, even depression; all the things we see after heart attacks are improved with cardiac rehab,” Noble said.

Cardiac rehab is a medically supervised program designed to improve the cardiovascular health of patients who have experienced traumatic heart problems. The rehab process includes three components: Exercise, counseling and training; education for heart healthy living; and counseling to reduce stress.

The new service, as envisioned, will be pretty straightforward but life-changing for the many local heart patients who must now make a two-hour round trip three times per week to get to rehab programs in Chittenden or Rutland counties.

“When we started this program, we viewed it through the lens of, ‘If you sprain your ankle in Middlebury, you can come get rehab at Porter; but if you have a heart attack in Middlebury, you have to get in the car and drive north or south to get cardiac rehab,’” said Tom Manion, vice president of the Porter Medical Group.

He called that scenario “unacceptable” for patients committing to the requisite 36, hour-long rehab sessions.

“There are a ton of people who have their heart attack and say, ‘I can’t do it; it’s a barrier for me to be able to (travel to rehab), so I’m not going to do it,’” Manion said. “And unfortunately, it’s a large amount of people.”

Manion said caregivers at Porter Medical Center last year treated patients who experienced a combined total of 190 heart attacks.

Fifty Addison County patients made the trek to UVM Medical Center for cardiac rehab services during fiscal year 2016, and another 36 did it in fiscal year 2017 officials said.

According to statistics provided by the American Heart Association, those who complete the 36 hours of cardiac rehab see:

• A decrease of 25-35 percent in the likelihood of cardiac-related death for patients with heart disease.

• A 20-30 percent reduction in mortality rates.

• Reduced symptoms, including angina, labored breathing and fatigue.

• Improved adherence with preventive medications.

• Increased exercise performance.

Each year, roughly 915,000 Americans will have a heart attack and more than 30 percent will have a second and potentially fatal event, according to the Heart Association. Around 2,300 Americans die of cardiovascular disease each day, an average of one death every 38 seconds.

Approximately 92.1 million American adults are living with some form of cardiovascular disease or the after-effects of stroke, according to the Heart Association. Direct and indirect costs of total cardiovascular diseases and stroke are estimated to total more than $329.7 billion; that includes both health expenditures and lost productivity.

“Cardiac rehab is a big thing, and it’s something we’re not doing very well around here,” Noble said. “It’s hard enough to get people into cardiac rehab programs, even though it’s been shown to have anywhere from 30-50 percent mortality reductions in people who have had a heart attack.”

The new cardiac rehab center will be equipped with such things as treadmills, elliptical machines, stairmasters and resistance machines.

Porter will hire exercise physiologists (1.5 full-time equivalent positions) and an office representative (0.7 FTE) to staff the center, according to the business plan.

“They’ll make sure everyone is rotating through their circuits the way they’re supposed to,” Manion said of staff.

Project planners are optimistic that Addison County patients will use the new cardiac rehab program once it’s put into place. Manion expects the Porter Medical Center offering could see a 40-percent growth in participation by 2022, and 78 percent growth by 2027.

Porter Medical Center data shows approximately 950 Addison County residents could benefit from cardiac rehab services, a number expected to grow to more than 1,300 by 2022, to more than 1,700 people in 2027.

“We know how many people could use it, but how many people are going to is a different question,” Manion said.

Manion believes there will be enough capacity at the center to accommodate all local patients in need of the service. Clients will rotate in and out every 12 weeks. Patients will initially be put on a Monday, Wednesday, Friday rotation, with the prospect of adding a Tuesday, Thursday, Saturday rotation if demand warrants, Manion noted.

“Everyone is excited about this,” Manion said. “It’s such a great, feel-good thing that we can actually build a service that is so great for people and that they might not otherwise get. Our docs are very excited about it.”

And so are prospective users.

“I’m hearing it from all my patients,” Noble said. “We’ve had people write letters.”

He added some patients immediately asked “When can I sign up?” when they got their first inkling that a local cardiac rehab facility was in the works.

While the new rehab service won’t be super profitable, it’s the right thing to do, according to Porter President Dr. Fred Kniffin. It will be another in a growing number of Porter services aimed at keeping local residents healthier and therefore less likely to develop chronic ailments requiring more expensive, invasive care.

“In a fee-for-service world, this will not be a huge moneymaker; we expect break-even financial performance, perhaps a bit better over time, but in the value world we are moving to where we are working hard to keep our patients healthy, all boats rise, and cardiac rehab becomes a big winner for us as well as for our patients,” Kniffin said. “And again, in any world, this is simply a service we should provide for our community.”

Reporter John Flowers is at johnf@addisonindependent.com.