The objectives of this analysis were to ascertain the population need for out-patient cardiac rehabilitation in England, to estimate the current level of provision and associated costs, to identify economies of scale in service provision and to investigate budgetary implications of extending provision.
Discharge statistics from the Hospital Episode Statistics database (HES) in England in the year 2000, and data from centres contributing to the British Association for Cardiac Rehabilitation (BACR) survey were analysed. A short follow-up questionnaire was sent to respondents of the BACR survey.
The main outcome measures were: the number of patients eligible for cardiac rehabilitation; the percentage referred, joining and completing programmes; health service costs associated with current levels of provision; elasticity of costs; and costs associated with expanding services. Using an inclusive definition of need, about 267,000 people required cardiac rehabilitation in England in the year 2000. This figure fell to 100,000 if services were restricted to those aged below 75 years with acute myocardial infarction, unstable angina or following revascularisation. Health service costs per patient completing a programme were £354 (staff) and £486 (total). Out-patient cardiac rehabilitation represented a NHS cost of approximately £12.5–19.0 million per annum. A 1% increase in patients completing a programme is estimated to lead to a 0.25% fall in the staff cost per patient. A budget increase of 630% would be necessary to treat all eligible patients using moderate staffing configurations, which would fall to 170% if only those aged below 75 years with restricted diagnoses were to be treated.
We conclude that a substantial proportion of the population need for cardiac rehabilitation goes unmet and that achievement of current targets for provision is likely to require considerable additional resources. Reconfiguration of service provision towards less complex services would enable more patients to be treated. Current information systems in cardiac rehabilitation services are inadequate to provide indicators of performance and monitoring.
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