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75,000 patients missing out on vital cardiac rehabilitation services, UK

Nearly 75,000 heart patients are missing out on crucial rehabilitation, according to a report on cardiac services.

Just 45% of patients who have a heart attack, angioplasty or bypass surgery receive cardiac rehabilitation, new statistics1 from the British Heart Foundation (BHF) have revealed.

The report, published recently, found that thousands of patients are missing out on vital services, and that cardiac rehabilitation programmes are failing to meet minimum standards.

The report reveals:

  • Only 33% of patients took part in rehabilitation following medicine-based treatment for a heart attack
  • 53% of patients given a stent after a heart attack went on to take part in rehabilitation
  • Heart attack patients are waiting as long as nine weeks to start rehabilitation, more than double the target time
  • No region is meeting the six-week target time to start rehabilitation after coronary artery bypass graft surgery (CABG).
  • Around two-thirds of regions did not meet the minimum length of cardiac rehabilitation of eight weeks. The recommended length of rehabilitation is 12 weeks.

The report used data from more than 250 cardiac rehabilitation programmes across 19 regions: 12 strategic clinical networks in England, two cardiac networks in Wales, and five health and social care trusts in Northern Ireland.

The National Audit of Cardiac Rehabilitation (NACR), which is funded by the BHF, combined data for the three nations and found that 135,000 patients were eligible for rehabilitation following a heart attack, angioplasty or bypass surgery in 2012/13.

But just 60,000 of those took part in cardiac rehabilitation afterwards. Uptake of cardiac rehabilitation has increased just 2 per cent since 2005/6.

Patients who had bypass surgery were most likely (80%) to take part in a rehabilitation programme.

Cardiac rehabilitation offers lifestyle advice and support, including diet and exercise, to help people living with heart disease to manage their condition and reduce the risk of associated heart events.

Previous research2 has shown that coronary angioplasty (PCI) patients who take part in cardiac rehabilitation can have up to a 39% reduction in cardiac mortality.

The audit showed that of those who took part in cardiac rehabilitation, the number of smokers halved and the proportion of people exercising for 150 minutes a week almost doubled and cholesterol levels improved. Patients’ psychological well-being also improved with fewer people having high levels of depression and anxiety.

Cardiac rehabilitation should be provided by teams made up of staff from a number of different professional groups to ensure that patients get the physical, social and psychological help they need. But worryingly, just 10 per cent of programmes have access to a psychologist.

The cost of putting a person through a cardiac rehabilitation programme is estimated3 at around £477.

Programmes have the potential to lead to savings for the health service by reducing cardiac-related readmissions to hospital.

The BHF is calling for all eligible patients to be referred to cardiac rehabilitation, and for health services to ensure that their programmes meet the necessary standards so that patients reap the full benefits.

Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, said:

“We have been warning health services about this uptake issue for years but we aren’t seeing sufficient progress.

“Governments across the UK, the NHS and NICE all agree that cardiac rehabilitation is a vital part of care for people living with heart disease, and yet less than half of eligible heart patients are receiving it.

“In seven years, since the first report, uptake of cardiac rehabilitation has stalled and crept up by just two per cent, while thousands of heart patients are missing out on lifesaving rehabilitation.

“The health service has had long enough to sort this out. They have all the tools and guidance they need to provide higher numbers of patients with better quality of cardiac rehabilitation.

“It is time for them to finally deliver a service that improves patients’ lives.”

Case studies

Nicola Brown, 51, from London, had a stent fitted after a heart attack in 2012. She took part in cardiac rehabilitation once a week, for six weeks, and still continues to go to the gym.

She said: “Everyone should be given the option to take part in cardiac rehabilitation.

“When you’re recovering from a heart attack it can be quite scary. I was just sent home with some pills and no one was there to tell me how to cope afterwards or what my limits were. I needed more guidance.

“But my cardiac rehabilitation programme was brilliant. Experts such as specialist cardiac nurses, nutritionists, and exercise instructors were there to educate and help us.

“At the end of rehabilitation I was feeling much better and still continue to go to the gym.”

Yvonne Genas, 55, from Nottingham had a heart attack in 2012 when she was aged 53. She did eight weeks of cardiac rehabilitation, twice a week, at a hospital and then a further 12 weeks at a gym.

She said: “Not to be offered cardiac rehabilitation at all is an injustice and it takes away from all the work the doctors have done to save you.

“It can be a bit of a postcode lottery, some people get offered rehabilitation and others don’t.

“From my experience, cardiac rehabilitation was absolutely vital.

“When I was recovering I went through a phase of not wanting to leave the house because part of me was scared I would have another heart attack.

“But after a few weeks of the rehabilitation programme I felt mentally and physically much better.

“At the end of the programme you see how much you have improved even in simple things like walking. It felt like a real achievement.”

Source

The number of patients receiving cardiac rehabilitation was collected using the NACR electronic database and via postal survey. 54 out of 272 programmes in England did not provide data. Where programmes did not provide data, the numbers were estimated using either previous year’s figures for that site if they confirmed the service had not changed, or using the median number calculated from those sites that had returned data.

1) Unless stated, all statistics from the National Audit of Cardiac Rehabilitation Annual Statistical Report 2014.

2) Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community. Kashish Goel et al. Published in Circulation. DOI: 10.1161/CIRCULATIONAHA.110.983536 http://circ.ahajournals.org/content/123/21/2344.long

3) Cost per patient of cardiac rehabilitation is based on staff costs only. Making the case for cardiac rehabilitation: modelling potential impact on readmissions, NHS Improvement, March 2013. Available here: http://webarchive.nationalarchives.gov.uk/20130221101407/http://www.improvement.nhs.uk/documents/Case_for_CR.pdf

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