Original ArticleCardiac Rehabilitation in Australia: A Brief Survey of Program Characteristics
Introduction
Cardiovascular disease (CVD) is the leading cause of death and health care expenditure in Australia [1], [2]. Patients who have had a cardiac event are at increased risk of a subsequent event and death, even after surgical intervention [3] and are, therefore, the priority for preventive cardiology efforts [4]. As such, evidence-based guidelines strongly recommended that structured multidisciplinary intervention via cardiac rehabilitation (CR) be offered to all patients after an acute event in order to improve patient outcomes [5]. Cardiac rehabilitation has been shown to reduce the risk of further heart attack or death by 25–30% [6], [7], significantly improve health-related quality of life [8] and is highly cost-effective [9], [10].
Centre-based group programs are the major systematic approach to CR currently available in Australia [11]. The core components of group CR are well documented [12], [13] and include physical, psychological and social assessment, education, self-care strategies and exercise components. The typical duration of most programs is 6 to 8 weeks [14]. Cardiac rehabilitation aims to restore individuals to their optimal level of physical, psychological, social and vocational wellbeing and is considered ‘an essential part of the contemporary care of heart disease’ [15]. Given the complex physical and psychosocial needs of patients [16], [17], ideally CR should involve multi-disciplinary teams of health professionals [14] which may comprise a cardiologist, physician or general practitioner with special interest, nurse specialist, physiotherapist, exercise physiologist, dietician, psychologist, occupational therapist, social worker, pharmacist, clerical administrator [13]. In practice, the nature of the CR workforce in Australia may be affected by the ‘tyranny of distance’ evident in rural, remote and Indigenous populations [18], [19] and the specific needs of the local population [13].
Increasing attention is now being paid to documenting common features of CR programs. This is in order to understand, for example, temporal trends in the socio-demographic and clinical characteristics of participants referred to CR, and their effect on program participation and all-cause mortality [20]. The usefulness of having benchmark data on CR program characteristics has also been demonstrated by comparing the differences in CR availability, structure, and resourcing between high income countries and low-and middle-income countries [21].
The annual audits undertaken by the National Audit of Cardiac Rehabilitation team in the UK, shows the utility of having systematically collected comprehensive benchmark data on program characteristics since 2005 [22], allowing comparison of CR programs at national, regional and local levels, and very importantly, comparison of program structures and performance against CR guidelines [23].
The primary aim of this study was to assess pre and post CR psychosocial screening practices [24], while a secondary aim was to conduct a brief snapshot survey of CR program characteristics on a national scale, as no such profile had been conducted in Australia previously.
Section snippets
Participants
Eligible participants were coordinators of 314 CR programs currently operating in Australia. The coordinator’s contact details were extracted from the Australian Directory of Cardiac Rehabilitation Services available on the Australian Cardiovascular Health and Rehabilitation Association (ACRA) website [25].
Measures
For the main study, an online survey was developed which asked about screening activities across a range of traditional and emerging CVD risk factors. In addition, coordinators were asked to
Results
Out of the 314 eligible CR programs contacted, a total of 192 (61.1%) commenced the survey. There were 27 (8.6%) incomplete responses resulting in a total of 165 (52.5%) respondents with complete survey data.
Discussion
Although the data collected on CR program characteristics were less extensive in this preliminary snapshot survey than those collected in the other studies referred to earlier [20], [21], [23], national coverage was good with the 165 responding programs representing half of all Australian CR programs. This compares with 8 Arab CR programs and 39 Canadian CR programs described in the Turk-Adawi et al. paper [21].
In contrast to Canadian CR programs, where, in more than 50% of the programs,
Conclusion
Even this brief survey of the characteristics of Australian CR programs is instructive, in highlighting differences in duration and multi-disciplinarity between these programs and their UK and Canadian counterparts. What would be very useful, however, is the creation of a common set of measurement criteria of CR programs which allows consideration of how well the programs implement national guidelines, or conform to recommendations of what the core components of CR should be [13]. Our suggested
Conflict of Interest
None declared.
Acknowledgement
We thank the Australian Cardiovascular Health and Rehabilitation Association (ACRA) for their endorsement in this project and thank all survey participants.
References (31)
- et al.
Exercise-based rehabilation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials
Am J Med
(2004) - et al.
Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews
Int J Cardiol
(2014) - et al.
Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services?A Cost Benefit Analysis
Heart Lung Circ
(2016) - et al.
Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014
Heart Lung Circ
(2015) - et al.
Psychosocial Screening and Assessment Practice within Cardiac Rehabilitation: A Survey of Cardiac Rehabilitation Coordinators in Australia
Heart Lung Circ
(2017) - et al.
Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis
J Am Coll Cardiol
(2016) - et al.
Do Cardiac Rehabilitation Programs Offer Cardiopulmonary Resuscitation Training in Australia and New Zealand?
Heart Lung Circ
(2016) Health-care expenditure on cardiovascular diseases 2008-09. Cat. no. CVD 65
(2014)- Australian Bureau of Statistics Causes of Death, Australia, 2015 (3303.0). Canberra;...
- et al.
The underlying risk of death after myocardial infarction in the absence of treatment
Arch Intern Med
(2002)