The Heart Manual Service provides concise summaries of medical conditions to help patients better manage their health. It has manuals on conditions like heart disease, stroke, and cancer. The service has trained over 1,500 facilitators. Studies show the manuals improve health outcomes by enhancing consultations, reducing readmissions and visits, and improving medication adherence. New developments include digital formats and collaborations to create manuals for other conditions.

1. The Heart Manual DepartmentThe Heart Manual Department
www.theheartmanual.comwww.theheartmanual.com
NHS LothianNHS Lothian
RI ConferenceRI Conference
Edinburgh, October 2016Edinburgh, October 2016

2. Aim:Aim:
a)a) To provide an overview of the Heart ManualTo provide an overview of the Heart Manual
ServiceService
b) How the Heart Manual works and its evidenceb) How the Heart Manual works and its evidence
c) Highlight new developments and collaborationsc) Highlight new developments and collaborations

3. The Heart Manual Service
HM Facilitator
Training (n = 1500)
HM Website
(700 hits/month)
Audit and
Research
Patient
Involvement HM
Group
Department’s
Portfolio
Collaborations
Lothian Health
Board
 Intellectual
Property Rights
 Trademarked
The Heart
Manual (HM)
Service
Edinburgh
Health and
Social Care
Partnership
Cancer Manual
(2014-2016)
Stroke Workbook
HM Programme
Revascularisation
Edition (n = 4000 p.a.)
HM Programme MI
Edition (n = 12000 p.a.)
Book
Digital
TIA Manual (2014  )
Book
Digital
 Exeter University (2012 – 2017)
 Heart Cycle (2010 - 2013)
 Queens University Belfast (2014 )
 Taunton H/C Trust (2014 – 2016)
Peking UniversityHospital (2016-
Heart Failure Manual
2012-17
*Mapofuse-Appendix
In use
In development/ trial
Shared IPR

4. a)a) The Heart Manual ServiceThe Heart Manual Service
 Intellectual Property Rights (IPR) / copyright sit with LHBIntellectual Property Rights (IPR) / copyright sit with LHB
The department’s portfolio includes:The department’s portfolio includes:
 MI edition(2016)- digitally formattedMI edition(2016)- digitally formatted
 Revascularisation edition (2015)-digitally formattedRevascularisation edition (2015)-digitally formatted
 Stroke Workbook (2011)Stroke Workbook (2011)
 Cancer manual (2016)Cancer manual (2016)
 Training/support of facilitators-from Scotland, rest of UnitedTraining/support of facilitators-from Scotland, rest of United
Kingdom and further afield-e.g: Canada, SingaporeKingdom and further afield-e.g: Canada, Singapore

5. www.theheartmanual.com
HM users
Canada
HEART MANUAL (HM)HEART MANUAL (HM)
(UK AND ABROAD)(UK AND ABROAD)
heart.manual@nhslothian.scot.nhs.uk
The Heart Manual Department
Administrative Block, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL
Canada
Republic of Ireland
Beijing
Singapore
Cayman Islands

6. The Heart Manual Service contd.,The Heart Manual Service contd.,
 Strong evidence base-3 RCTs (1994, 2007,2009)Strong evidence base-3 RCTs (1994, 2007,2009)
 330 citations of HM in journals (1990-2015)-as an excellent330 citations of HM in journals (1990-2015)-as an excellent
example of a facilitated, sustainable & comprehensive resource.example of a facilitated, sustainable & comprehensive resource.
 HM facilitators n=1500HM facilitators n=1500
 15,000 manuals per annum15,000 manuals per annum
Recent collaborations include:Recent collaborations include:
 2010-132010-13 Philips Heart Cycle-Heart Failure telehealth -EuropePhilips Heart Cycle-Heart Failure telehealth -Europe
 2012-172012-17 NIHR grant/National collaboration-HF manualNIHR grant/National collaboration-HF manual
 2013-162013-16 Cancer Manual-in collaboration with Taunton NHSCancer Manual-in collaboration with Taunton NHS
 2014 -2014 - TIA /Healthy Brain Manual-in collaboration with QUBTIA /Healthy Brain Manual-in collaboration with QUB

7. Traditional approachesTraditional approaches
 Hospital or communityHospital or community
based classes effectivebased classes effective
and useful for those whoand useful for those who
like groups and canlike groups and can
access the classesaccess the classes
 However more peopleHowever more people
returning to work quicklyreturning to work quickly
after an event,after an event,
intervention or diagnosisintervention or diagnosis
 More flexible deliveryMore flexible delivery
approaches neededapproaches needed

8. 88
Heart Manual MI and RevascularisationHeart Manual MI and Revascularisation
EditionsEditions
 Part 1:Part 1: Your Heart Condition: the factsYour Heart Condition: the facts
Read during hospital stay, CDRead during hospital stay, CD’’ss
 Part 2:Part 2: The 6 weekly facilitated home programme,The 6 weekly facilitated home programme,
Week 1 Getting home - getting betterWeek 1 Getting home - getting better
Week 2 Feeling better, smokingWeek 2 Feeling better, smoking
Week 3 Making progress, dietWeek 3 Making progress, diet
Week 4 Getting better all the time, weightWeek 4 Getting better all the time, weight
Week 5 Feeling more like yourself, exerciseWeek 5 Feeling more like yourself, exercise
Week 6 The endWeek 6 The end……and the beginning, blood pressureand the beginning, blood pressure
DailyDaily –– Relaxation, Walking, Exercise and Activity recordRelaxation, Walking, Exercise and Activity record
 Part 3:Part 3: Facts and advice to aid recoveryFacts and advice to aid recovery

9. Evidence baseEvidence base
 AnxietyAnxiety
 DepressionDepression
 QoLQoL
 Health perceptionHealth perception
 Exercise knowledgeExercise knowledge
 SmokingSmoking
 Exercise levelsExercise levels
 Cost effectivenessCost effectiveness
 BPBP
 CholesterolCholesterol
 Cardiac symptomsCardiac symptoms
 Programme AdherenceProgramme Adherence
 Self-reported behaviourSelf-reported behaviour
 GP visitsGP visits
 Hospital re-admissionsHospital re-admissions
Lewin et al (1992) Dalal et al (2007)Lewin et al (1992) Dalal et al (2007)
Taylor (2007) Jolly (2007, 2009)Taylor (2007) Jolly (2007, 2009)
Henwood & Barnes (2008)Henwood & Barnes (2008)
Dalal et al (2010,2015)Dalal et al (2010,2015)
99

10. Think, Do, EmpowerThink, Do, Empower
 Heart Manual programme :Heart Manual programme :
-explores & challenges misconceptions,-explores & challenges misconceptions,
normalising experiences,normalising experiences,
-develops strategies for dealing with stress-develops strategies for dealing with stress
-Helps people-Helps people dodo something about theirsomething about their
condition –condition –
- planning, goal setting, self-monitoring- planning, goal setting, self-monitoring

11. 1111

12. Heart Manual TrainingHeart Manual Training
 2 day Heart Manual2 day Heart Manual
Facilitator CourseFacilitator Course
 1 day Health Care1 day Health Care
Support WorkersSupport Workers
coursecourse
 1 day Update day1 day Update day
 2 day Trainers course2 day Trainers course

13. Facilitation of the Heart ManualFacilitation of the Heart Manual
Heart Manual
MI or
Revascularisation
Editions/
Hard copy or Digital
Hospital facilitation
Spec nurse or
trained
facilitator
Phone follow up
Home visit
Clinic review/
Specialist ax
Phone follow up
Home visit
Spec nurse or
trained facilitator
Clinic setting
Spec nurse or
trained facilitator
Discharge to
GP/Practice nurse
Referral to specialist
Service for 1:1
Community
Cardiac
Rehab class
Stand alone
Exercise class e.g. BACPR
Instructor or local gym
Community facilitation

14. HOW
THE CANCER MANUAL
EVOLVED…

15.  Support patientsSupport patients
living with & beyondliving with & beyond
cancercancer
 Address frequentlyAddress frequently
asked questionsasked questions
 Help support &Help support &
encourage positiveencourage positive
behavioural changesbehavioural changes
 Be facilitated byBe facilitated by
specially trainedspecially trained
cliniciansclinicians
A RESOURCE TOA RESOURCE TO

16. In summary…..In summary…..
The Heart Manual embraces self-management as it….The Heart Manual embraces self-management as it….
 Enhances health consultationsEnhances health consultations
 Reduces GP consultationsReduces GP consultations
 Improves hospital readmission ratesImproves hospital readmission rates
 Reduces in patient staysReduces in patient stays
 Reduces outpatient visitsReduces outpatient visits
 Provides understanding for the familyProvides understanding for the family
 Improves medication compliance andImproves medication compliance and
managementmanagement
 Reduces A & E attendanceReduces A & E attendance
Jones (2007), DoH (2006), (2007), (2008) Dalal (2010,2015)Jones (2007), DoH (2006), (2007), (2008) Dalal (2010,2015)1616

17. 1717
“The Manual more than
met my expectations, and I
still refer to it now – six
months after my heart
attack”
“The sections on risk factors
helped me make informed
decisions with regard to my
lifestyle”
“My facilitator has always
been understanding,
informative and supportive”
“All the feelings and
fears I had, I found
they were common
and it explained why
we feel like this”

18. 1818

19. Thank youThank you
jennifer.elliott@nhslothian.scot.nhs.ukjennifer.elliott@nhslothian.scot.nhs.uk
www.theheartmanual.comwww.theheartmanual.com