National database needed for cardiac rehab – survey
National database needed for cardiac rehab – survey
Cardiovascular disease is the number one killer in New
Zealand, accounting for 30 per cent of all deaths annually.
But a new survey shows there is a wide variety in cardiac
rehabilitation services with little information on the
impact of the different models.
The survey was funded by the Heart Foundation and the New Zealand Cardiovascular Prevention and Rehabilitation Group and conducted by researchers from Massey University’s College of Health. It revealed that one in four of 42 service providers did not regularly audit their services. This was despite guidelines recommending six-monthly audits to ensure services are on track with patient needs, and to monitor patient outcomes.
A report on the survey is calling for a national database of information to be established. It says this would give a comprehensive view of service provision and patient outcomes to assess efficacy, with the aim of learning from services that are performing most strongly and strengthening the quality of others.
Research team leader Dr Geoff Kira, from the Research Centre for Māori Health and Development at Massey, says a national database of cardiac rehabilitation services would ensure consistency of quality care measures, as well as identify areas where more funding and services might be needed.
The survey was undertaken because of; “the poor understanding of the mix and make-up of existing CR [cardiac rehabilitation] programmes across New Zealand and their alignment with evidence-based guidelines.”
Of 46 cardiac rehabilitation services nationwide, 86 per cent completed the survey. Results showed the programmes vary in duration from one day to 12 weeks, with an average of six weeks. Half of the services provide a weekly session. Cardiac rehabilitation is delivered in three phases: inpatient and outpatient rehabilitation, and long-term health maintenance.
Survey questions probed the
following areas: structure of the units and services
provided; available resources and employees; inclusion and
exclusion criteria; and how services meet the needs of
under-represented groups. It also asked about programme
format and content, session frequency, locations,
assessments and referral processes, as well as quality
assurance including recording of attendance, and monitoring
of outcomes for the third phase of rehabilitation. Research
assistant Grace Humphrey, a Bachelor of Sport and Exercise
(Exercise Prescription and Training), developed the draft
survey, prepared the online survey tool, and followed up
cardiac rehabilitation service unit
As well as variations
in content and delivery of cardiac rehabilitation, the
report found there was also no clear standardised process
guiding patient assessment, despite guidelines encouraging
assessments and re-assessments in nutrition (dietetic
support), smoking status, social support and anxiety or
depression, as well as pre-exercise risk.
“It is uncertain whether the diversity is due to patient need or an effect of environmental influences, for example, policy and funding,” the report’s authors say.
The Heart Foundation’s Heart Healthcare Manager, Kim Arcus, says cardiac rehabilitation is a vital part of recovery for heart attack patients, which is why the charity was keen to support this research.
“Cardiac rehab services in New Zealand work really hard and are doing the best with what they have. We’re actually quite comfortable with the fact that there’s an element of variety in the way programmes are being delivered. However, we’d like to see much more consistency in the way outcomes are measured,” he says.
“A national database would allow us to measure results and then compare those results to find out what’s working best. Services could learn from each other and adapt to achieve the best outcomes for patients.”
International research has found that attending cardiac rehabilitation improves health outcomes, so uptake and attendance data should be deemed essential, the report adds. Standardising and centralising unit and patient data would create an accurate profile of regional differences in service provision – and this would give important understandings of how these might be linked to patient outcomes.
Dr Kira says a nationally coordinated cardiac rehabilitation service registry– such as in Europe and Britain, and being called for in Australia – would help with government policy and decision-making.
“Essentially it comes back to maximising the precious
health dollar for the benefit of patients and their
families, no matter where they live,” he says. “Cardiac
rehab has a major role to play in getting patients back to
participating in a meaningful life, whether returning to
work, playing sport or being able to help out in their
family or community.”
ends