Utilisation of outpatient cardiac rehabilitation in Queensland

Abstract

Objectives: To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs. Design and setting: Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs. Participants: Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private). Main outcome measures: Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance. Results: 15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality. Conclusion: There is significant underutilisation of facility‐based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.

Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-year follow-up of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) randomised controlled trial

“…In Australia, the majority of cardiac rehabilitation services are hospital-based, group programmes for a defined period of about 6–12 weeks. Despite rehabilitation being funded within the public hospital system, attendance rates are relatively low at 10–30%2 but are comparable to international figures. In this study, it was encouraging that about 40% of eligible patients not accessing rehabilitation volunteered.…”

“…Providing acute coronary syndrome (ACS) survivors with active choice about their secondary prevention uniquely addresses the substantial international underuse of cardiac rehabilitation 1 2. Despite widespread recommendations3 – 5 that all ACS survivors participate in secondary prevention, only a minority attend existing rehabilitation programmes 1 2.…”

“…Despite widespread recommendations3 – 5 that all ACS survivors participate in secondary prevention, only a minority attend existing rehabilitation programmes 1 2. Therefore, secondary prevention opportunities for extending survival, reducing cardiovascular events, decreasing revascularisation rates and enhancing quality of life (QoL)6 7 are often lost.…”

Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol: Figure 1

“…While there is clear evidence that secondary prevention strategies are often effective,6 there is also clear evidence that they are commonly underutilised 3 4 8. Mobile phone interventions that are simple, inexpensive and use current technology could potentially be a useful complement to existing prevention programmes.…”

“…In the USA,4 UK3 and Australia,7 8 only about a third of eligible patients participate in cardiac rehabilitation. Furthermore, non-attendees are at higher baseline risk and have poorer risk factor knowledge than those accessing rehabilitation 9.…”