Elsevier

Heart, Lung and Circulation

Volume 27, Issue 12, December 2018, Pages 1415-1420
Heart, Lung and Circulation

Original Article
Cardiac Rehabilitation in Australia: A Brief Survey of Program Characteristics

https://doi.org/10.1016/j.hlc.2017.08.024Get rights and content

Background

Defining cardiac rehabilitation (CR) program characteristics on a national level is crucial for decision-making on resource allocation and evaluation of service quality. Comprehensive surveys of CR programs have been conducted overseas, but, to date, no such profile had been conducted in Australia.

Methods

A representative sample of 165 CR programs across Australia were asked to provide details on a range of program characteristics such as program location and size, program elements, and staffing profile.

Results

Australian CR programs differ from their overseas counterparts in characteristics such as program length, number of sessions, number of specialities represented and extent of outreach.

Conclusions

The study findings point to a need for a routine comprehensive survey of CR programs throughout Australia.

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.

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