2011, Volume 18, Supplement 1: Setting the standard for cardiac rehabilitation

Robust clinical and economic evidence suggests that cardiac rehabilitation (CR) should be an important and integral component of care for many patients with heart disease. Nationally, the mean uptake for cardiac rehabilitation is as low as 38% of appropriate patients, with widespread geographic variation.1 The launch of the National Audit of Cardiac Rehabilitation (NACR) in 2007 focused attention on the importance of access to specialist rehabilitation services in the effective management of patients with coronary artery disease and heart failure. The campaign, led by the British Heart Foundation (BHF) with support from the British Association of Cardiac Rehabilitation (BACR), demands that all patients who might benefit should be able to access CR services, either in a medical setting or at home....

Current statistics, available from outcomes following the National Service Framework (NSF) on Coronary Heart Disease,1 show that more people are surviving longer both after an acute coronary event and after a symptom-led diagnosis of coronary artery disease. In the past, cardiac rehabilitation (CR) played a key role in preventing premature mortality2 but more recently the greatly enhanced emergency services, better public education and more aggressive and widely available medical interventions may have diminished the effect of CR on premature mortality. There is now an increasing focus on productivity of life in those surviving acute myocardial events. Productivity refers to people’s active involvement in the local social and economic fabric of their families, friends and community. Some of these matters are less likely to be a function of technical medical care but rather a function of healthcare professionals providing therapeutic and health-promoting support for people to manage the physical, mental, domestic, occupational and social aspects of their lives – all of the goals at the heart of a good CR and chronic disease management and prevention programme....

Cardiac Rehabilitation (CR) provision in cardiac care remains the ‘unfinished business’ of the National Service Framework (NSF) for Coronary Heart Disease 2000. The Cardiovascular Networks always promised to be effective health communities across which sharing good practice, and ultimately designing ideal care pathways including CR, to be commissioned against key defined outcomes, could be made. The Myocardial Ischaemia National Audit Project (MINAP) initially overestimated referral to CR, as clarified by the first National Association for Cardiac Rehabilitation (NACR) audit of 2005/2006.1 ...

Recent data from the 2009/10 national diet and nutritional survey show that the national dietary pattern has improved.1 Intake of saturated fats, trans fats and added sugar is lower than it was 10 years ago.1 Nonetheless, saturated fat intake remains greater than the 11% recommended level, at 12.8%; fruit and vegetable intake is estimated to be 4.4 portions/day; fibre 14 g/d and oily fish <1 portion per week. So improvements are still required in order to meet recommended targets.1...

The Cardiac Prevention & Rehabilitation Service (CP&R) at Imperial College Healthcare NHS Trust in London uses both community- and hospital-based programmes. A community-based programme, called MyAction, serves the Westminster population, while a hospital-based service from Charing Cross Hospital serves the Hammersmith and Fulham population, and also accepts patients from Hounslow, Ealing and other areas. ...

Current data from the National Audit for Cardiac Rehabilitation (NACR) report that the average uptake of cardiac rehabilitation (CR), which includes exercise, is about 38%; ranging from 30% in patients following angioplasty to 68% for patients following bypass surgery.1 The NACR has highlighted numerous potential reasons for this lower than desired uptake, including the quality of local referral and patient recruitment processes, patient education and socio-cultural barriers to access.1 These problems are not exclusive to the exercise component of CR but affect the whole programme. This article will focus on the factors that CR professionals must consider in order to influence favourably the sustained longer-term participation in beneficial exercise for those patients who have taken up CR....

North West London To try and identify local barriers and share good practice, we have been regularly reviewing our cardiac rehabilitation (CR) services in North West London. Through this process we hope to increase the average uptake in a step-wise fashion from 50–60% to the national target of 85%.1 Lack of appropriately funded services and … Continue reading START: insights from the regions →...