Public health

Cardiac rehab has issues too

The Heart Foundation’s chief medical advisor has renewed calls for a national annual audit of cardiac rehabilitation programs.

Cardiologist Professor Garry Jennings says that despite the proven benefits of cardiac rehabilitation, too many patients are continuing to slip through the cracks when they leave hospital after their heart attack.

The most recent Heart Foundation Heart Attack Survivors Survey 2015 showed only 38% said they were advised to attend cardiac rehabilitation by hospital staff.

“I suspect the story is still the same,” Professor Jennings told the limbic.

According to an information statement for health professionals published by the Heart Foundation this year, patients who participate in a cardiac rehabilitation program are 40% less likely to be readmitted to hospital within 12 months and 25% less likely to die from another heart attack.

The economic benefits of promoting cardiac rehabilitation programs are impressive. While the heart attack costs the health system around $30,000 – equating to $1 billion each year, cardiac rehabilitation costs on average $885 for a person to attend.

The survey also revealed that 80% of patients would attend cardiac rehab, if they were advised to be their health professional.

Professor Jennings said it appeared the problem stemmed from a lack of referral at discharge from hospital. In fact he said he was also concerned about the lack of follow-up advice also offered in terms of returning to work, diet and exercise.

“We’ve been struck by the lack of information exchange when they leave hospital,” he said. “The big gap is people being referred to the service in the first place.”

He said it could be as simple as communication breakdown.

“I think that the medical staff thing the nursing staff have done it, the nursing staff think the GP will do it and the GP thinks it’s been done,” he said.

A national audit of all current cardiac rehabilitation programs would help identify the barriers to people accessing them after a heart attack. “We’re not finding any change,” he said.

He said it could be worth considering whether the concept of cardiac rehabilitation needed a rebrand to encourage more people to want to do it, conceding patients may misunderstand the process to be a long and arduous commitment.

“These programs these days are pretty tailored and time efficient,” he said.

Professor Jennings said he was frustrated that there seemed to be such a gridlock with getting patients to programs that are going to give them as greater chance of avoiding a second event.

Foundation figures show that in fact 40% of patients are less likely to be readmitted to hospital and 25% less likely to die from another heart attack.

“This is another example of so many of the issues that are not giving us the best health system we could have,” he said.

But Australia is not alone. A recent Spanish systematic review published in the International Journal of Cardiology that looked at the existing literature analysing factors that affect participation and adherence to cardiac rehabilitation programs.

The authors reviewed 29 studies from Medline, EMBASE and Cochrane databases from between 2004-2016 and found general consensus that participation and adherence to cardiac rehabilitation programs is low despite their effectiveness.

They also found that participation follows a determined pattern that is very homogeneous everywhere, with the most frequent variables affecting participation are age, gender and retirement.

Professor Jennings said he was not surprised by the findings, and they served to further support the need for an audit.

“We tend to focus on the front end of the heart attack,” he said. “We need to do more than that.”

The Heart Foundation has developed a Cardiac Rehabilitation Advocacy Strategy that can be accessed here.

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