UK
Database to revolutionise 'Cinderella' Cardiac Rehabilitation Services in the UK
By British Heart Foundation
Jul 7, 2005, 18:18

Just one third of the 220,500 patients who survive a heart attack or undergo bypass surgery or angioplasty each year currently take part in cardiac rehabilitation, well short of the Government's target of 85%, enshrined in the National Service Framework (NSF) for coronary heart disease (CHD).

And there are large geographical and social disparities, with the take-up in London estimated to be just 18% and lower take-up among women, the elderly, and some ethnic minority groups.

Furthermore, when angina, heart failure and other heart patients are included - as the NSF intended they would be once the initial targets were met - the take-up is even worse, with less than one in seven (14%) of the total 389,000 eligible patients estimated to be accessing services that could help them improve their lifestyle and help prevent them dying prematurely from the UK's biggest killer.

That is why the British Heart Foundation (BHF) has today launched a �1 million audit project aimed at revolutionising the way cardiac rehabilitation services in the UK operate. The National Cardiac Rehabilitation Audit Project will, for the first time, begin to harvest quality data about the effectiveness and uptake of cardiac rehabilitation programmes across the UK.

Cardiac rehabilitation is recognised as one of the most effective ways of helping to prevent heart patients suffering further heart attacks or other cardiac problems, and helping them return to as full and active a life as possible.

Professor Peter Weissberg, Medical Director of the BHF, said: "We know that far too few patients take part in cardiac rehabilitation and that most programmes are understaffed, but until now, we have not had reliable data to back this up. Without good data, it will be impossible to achieve the improvements needed: NHS services cannot be reformed on a hunch."

He added: "That is why the BHF is investing �1 million into this project � we believe it has the potential to bring help and hope to thousands of heart patients who currently leave hospital unsure how to rebuild their confidence and reduce their risk of future problems."

The project is a collaboration between the BHF, the British Association of Cardiac Rehabilitation (BACR), the Healthcare Commission, the Central Cardiac Audit Dataset project, the Royal College of Physicians, the Department of Health and the CHD Collaborative, as well as clinicians and patients.

From today, cardiac rehabilitation centres across the UK will be able to sign up to start feeding information about every patient they treat into a central database, which will be constantly analysed to find ways of improving and benchmarking services.

The data will show who is taking part in cardiac rehabilitation courses and who is not. It will offer answers on why some patients are not taking part and detail what patients gain from their courses. It will help identify centres that are under-staffed and enable resources to be targeted at those most in need.

And fundamentally, it will tell us more about the needs of the 2.7 million patients living with coronary heart disease in the UK, enabling future services to be designed around these needs.

The project has been designed by The British Heart Foundation Care and Education Research Group at the University of York, led by Professor Bob Lewin. His team have piloted the project at 15 centres across the UK for more than a year with great success.

Among the new sites taking part are the 36 programmes set up across England this year by the BHF with a �4.7 million award from the Big Lottery Fund, and 21 of the 22 centres in Wales. By the end of this year, a quarter of all UK cardiac rehabilitation programmes will be using the new database and it is hoped that, by 2007, most of the 372 UK programmes will be on board.

The audit is modelled on another highly successful centralised data project, the MINAP database, which has directly led to vastly improved treatment strategies for heart attack victims being uniformly spread around the country.

Malcolm Walker, President of the BACR, said: "Cardiac rehabilitation has for too long been a Cinderella service, with many centres relying on small numbers of professionals striving to provide services to increasing numbers of potential beneficiaries.

"This is despite cardiac rehabilitation having a strong evidence base that shows it can save lives and improve patient wellbeing.

"I am very excited about the prospects for cardiac rehabilitation now the National Cardiac Rehabilitation Audit Project is underway. The audit will provide the data upon which cardiac rehabilitation programmes will be able to compete effectively for resources and place the UK in a unique position to plan high quality, evidence-based services for heart patients.

"This will help cardiac rehabilitation programmes confirm their place as an essential component of the chronic disease management that is required to deal with heart disease, in all its various guises, from risk prone behaviour all the way to heart attack and cardiac surgery recovery."

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