Working together for stronger hearts

Living with heart disease or knowing you are at high risk for cardiovascular illness can be overwhelming. But a specialized province-wide heart health program is teaching Nova Scotians how to rebuild strength, restore confidence and reduce future risk. 

REDUCE-IT Cardiovascular Rehabilitation is a cardiovascular prevention, management and rehabilitation program developed by the Division of Cardiology for Nova Scotia Health and Nova Scotians. 

It’s rooted in evidence-based science and informed by Nova Scotia Health’s cardiovascular team, bringing nurse practitioners, dietitians, physiotherapists, registered nurses and other specialists together to deliver comprehensive, patient-centered care.  

“Participants leave feeling empowered to maintain healthy habits long after the program ends,” said REDUCE-IT manager and co-lead Wanda Firth. 

Paulette McKenna’s journey with the program began more than a year after her heart attack. On July 1, 2024, she was at home when she felt sudden chest pain and tingling down both arms and into her hands. She knew something was wrong. A physician in the emergency department at Cape Breton Regional Hospital later confirmed she had a heart attack.  

The diagnosis came as a shock. For 40 years, McKenna worked as a physiotherapist and considered herself active and health conscious. When she joined REDUCE-IT last fall, she said the program gave her an “entire toolbox” to support her recovery and long-term heart health. 

Over 12 weeks, participants living with heart disease or at high risk of cardiovascular illness receive supervised exercise sessions, individualized nutrition guidance, and take part in education designed to build confidence. 

"Every day in the program I learned something new,” McKenna said. “I feel I have a better grasp on how I can prevent another heart attack. The more information you have about your own health, the better.” 

What makes this program unique is the high degree of communication and networking between program staff. 

“We have a strong belief in team spirit. Beyond standardized training, we are building true collaboration across sites. Clinical and management teams are forming connections, supporting one another, and creating a provincial network that simply did not exist before. It is wonderful to see,” Firth said. 

At the heart of REDUCE-IT is a unique 1:1:1 core health team ratio of a registered nurse, dietitian and physiotherapist. Unlike traditional cardiac rehabilitation programs, a nurse practitioner works closely with a specialist to monitor and adjust medications in real time.  

What sets the program apart is real-time medication management.  

“Aggressive management of risk and disease leads to higher quality and quantity of life,” said Dr. Nicholas Giacomantonio, provincial medical director and REDUCE-IT co-lead. “We are aggressive in what we do. The aggression is within the sweet spot of highest benefit within 90 days of a patient’s referral.” 

He explained REDUCE-IT is not simply encouraging patients to walk more or follow general dietary advice. Exercise is prescribed based on stress testing, with clear targets for intensity and duration. Nutrition guidance is individualized rather than generic. Risk factors such as diabetes, obesity, smoking, high cholesterol and heart failure are treated as part of a comprehensive package. This proactive approach helps manage risk factors early, reducing the likelihood that disease becomes chronic. This is a standardized approach across REDUCE-IT province-wide. 

“Working with the dietician and learning about fibre, sugar, milk fats and more has been eye opening. The little everyday lifestyle adjustments I’ve made because of what I’ve learned has helped me significantly improve my diet,” McKenna said. 

Since launching in 2023, REDUCE-IT has expanded to eight sites across Nova Scotia, including Antigonish, New Glasgow, Bridgewater, Yarmouth, Halifax, Dartmouth, Lower Sackville and Sydney. The program continues to grow, increasing access to cardiovascular rehabilitation across the province. 

“Being an early REDUCE-IT site has helped us deliver more timely, high-quality cardiac rehab,” said Lisa MacDonald, manager and physiotherapist at the Sydney site, one of the first to implement the program. “With improved workflows and real-time guideline-directed medical therapy from our nurse practitioner, our team feels more supported, and our patients are receiving care that truly makes a difference.” 

Patients leave the program with a clear summary of their risk factors, lab results, medications and personalized guidelines for ongoing heart health. This summary then supports primary care providers by giving them actionable information to continue care and improve long-term outcomes for patients.  

“We are evaluating almost everything,” said Firth. “We are looking at how many people join the program, how many are assessed by the health team, how medications are adjusted and how risk factors improve from start to graduation.” 

Beyond physical recovery, McKenna said the emotional toll of a cardiac event can be significant. 

“There is a stress element to having a heart attack and worrying about having another one,” she said. “I’ve learned some exercises and tools to help me deal with some of that worry and stress. Everything I’ve gained in the program are takeaways that I’ll have for the rest of my life.” 

As Heart Month encourages Nova Scotians to reflect on their own heart health, REDUCE-IT highlights what is possible when you combine collaborative teams with early intervention and patient-centered care.  

Photo of REDUCE-IT patient, Paulette Mckenna.