National Audit Of Cardiac Rehabilitation Research Articles

What are the determinants of change in walking fitness in patients with a history of depression following cardiac rehabilitation?

This study aims to investigate the demographic, clinical, and service-level factors determining change in walking fitness in cardiac rehabilitation (CR) patients with a history of depression following the CR programme. The National Audit of Cardiac Rehabilitation clinical data were used to identify 1476 patients with a history of depression who had their pre- and post-incremental shuttle walk test (ISWT) recorded between 1 January 2016 and 31 January 2020. A multiple linear regression was conducted to examine the determinants of change in walking fitness (m) following CR. Mean age was 61 (SD 10.45), and mean ISWT distance at baseline and outcome was 352.06 m (SD 169.48) and 463.43 m (SD 197.65), respectively. Multivariate analysis revealed that change in walking distance reduced by 1.6 m for each year increase in age at baseline (P < 0.001). Females and unemployed patients had less improvement in walking fitness (23.1 and 21.5 m, respectively). Having a body mass index (BMI) > 30 was associated with lower improvement (24.2 m, P < 0.001), while physically active patients had 14.6 m higher change. Higher baseline ISWT quintiles were associated with less improvement, and increased waiting time to start CR was associated with reduced change in walking fitness following CR. Older age, female gender, unemployment, higher baseline BMI, longer waiting time, and lower physical activity were associated with reduced walking fitness improvement in patients with a history of depression. Targeted intervention and prompt access to CR can optimize outcomes.

Protocol for an implementation study of group metacognitive therapy for anxiety and depression in NHS cardiac rehabilitation services in England (PATHWAY-Beacons).

Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life and reduce the risk of further cardiac events. Depression and anxiety are common among CR patients but psychological treatments have usually had small effects. In contrast, the recent NIHR-funded PATHWAY trial found that group Metacognitive Therapy (MCT) was associated with improvements in anxiety and depression when added to CR and was more effective than usual CR alone. The next stage is to test implementation of MCT within the National Health Service through the creation of a network of CR beacon sites. The study will test the quality of data capture following addition of a new MCT data-field to the national audit of cardiac rehabilitation (NACR), examine level of adoption at sites, examine mental health outcomes benchmarked against usual CR and the PATHWAY data, examine the enablers and barriers to implementation and the expected resource requirements. The study has been registered: NCT05956912 (13th July, 2023). Beacon sites will be recruited as preliminary adopters of group MCT from NHS CR services in England. A national invitation for expressions of interest from CR services will be issued and those meeting eligibility criteria will be considered for inclusion. Two staff at each site will receive training in MCT, and mixed-methods will be used to address questions concerning the quality of patient data recorded, level of adoption at sites, the characteristics of patients attending MCT, the impact of adding MCT to CR on mental health outcomes, and patient, healthcare staff and commissioner views of barriers/enablers to implementation. Exploration of implementation will be informed by Normalisation Process Theory. The study will support development of an NHS roll-out strategy, assess the mental health outcomes associated with MCT, examine treatment fidelity in real-world settings, and evaluate revised data collection structures that can be used to assess the impact of national-level implementation. NCT05956912; 13th July 2023.

Screening for - and prevalence of - anxiety and depression in cardiac rehabilitation in the post-COVID era. An observational study

BackgroundApproximately 20–30% of patients with a cardiac disease suffer from anxiety and/or depression, leading to poor health outcomes. To identify this subgroup, clinical guidelines recommend screening for anxiety and depression in cardiac rehabilitation (CR). It is unknown how screening practice is delivered post-COVID. MethodsThis observational study used data from the National Audit of Cardiac Rehabilitation from April 2018–March 2022. Descriptive statistics were used to assess screening rates and prevalence, while a multivariate logistic regression model was performed to analyse determinants for screening for anxiety and depression among patients participating in cardiac rehabilitation. ResultsThe population consisted of 245,705 patients, where 128,643 (52.4%) were screened and 117,062 (47.6%) were not. Patients attending CR during first year of COVID-19 were less likely to be screened. Patients with female gender, living alone, non-white ethnicity, living in the most deprived areas, current smoking, and physical inactivity were less likely to be screened, while patients who were revascularized, having an objective physical fitness test, and attending a certified CR center were more likely to be screened. For patients attending CR during COVID-19, the prevalence of anxiety and depression decreased significantly. For anxiety the prevalence dropped from 34.4% to 15.8%, for depression the prevalence dropped from 33.5% to 16.5%. ConclusionCR service provision was negatively impacted during COVID-19, leading to much lower screening for anxiety and depression in the CR setting. Prevalence of anxiety and depression decreased during COVID-19 for this population, possibly because psychologically affected patients refrained from attending CR.

Factors associated with new-onset depressive symptoms in patients starting cardiac rehabilitation: Pre-COVID-19 and COVID-19 period comparison

ObjectiveWe aim to: 1) investigate whether starting cardiac rehabilitation (CR) during the COVID-19 period was influential on new-onset depressive symptoms, 2) examine the relationship between sociodemographic and medical factors with the new-onset of depressive symptoms before and during the COVID-19 period in UK patients commencing CR. MethodsThe national audit of cardiac rehabilitation (NACR) data were used and the two years of data before COVID-19 and during COVID-19 were analysed (Feb,2018 – Nov,2021). Hospital Anxiety and Depression Scale measurement was used to assess depressive symptoms. Bivariate analysis and logistic regression were conducted to examine the influence of the COVID-19 period on new-onset depressive symptoms and the patient characteristics associated with it. Results71055 patients screened for new-onset depressive symptoms were included in the analysis. Based on multivariate analysis, patients commencing CR during COVID-19 were 8% more likely to have new onset depressive symptoms compared to patients commencing before COVID-19. Smoking (OR: 1.26, 95%CI: 1.11, 1.43), physical inactivity (OR: 1.86, 95%CI: 1.74, 1.98), high anxiety (OR: 1.45, 95%CI: 1.44, 1.46), being male (OR: 1.21, 95%CI: 1.12, 1.30), single (OR: 1.25, 95%CI: 1.16, 1.35), having comorbidities of arthritis, diabetes, chronic bronchitis, emphysema, claudication (OR range: 1.19 to 1.60), receiving CABG treatment (OR: 1.47, 95%CI: 1.25, 1.73), and having heart failure (OR: 1.33, 95%CI: 1.19, 1.48) were the factors associated with having new-onset depressive symptoms at the start of CR. ConclusionOur findings have shown that starting CR during the COVID-19 period was associated with increased odds of having new-onset depressive symptoms.

Achieving cardiac rehabilitation uptake targets: What is the value case for commissioners? A UK case-study

Cardiac Rehabilitation (CR) has become an established intervention to support patient recovery after a cardiac event, with evidence supporting its effectiveness and cost-effectiveness in improving patient health and reducing future burden on healthcare systems. However, this evidence has focussed on the national value case for CR rather than at the point at which it is commissioned. This analysis uses the UK as a case-study to explore variation in current CR engagement and disassemble the value case from a commissioner perspective.Using data collected by the National Audit of CR (NACR), and an existing model of cost-effectiveness, we present details on the current level of CR uptake by commissioning region (Specialist Clinical Networks) in light of the current UK target of achieving 85% uptake. We then interrogate the value case for achieving the target at a commissioner level, highlighting the expected profile of health benefits and healthcare system costs over the long-term. Importantly we consider where this may differ from the national value case.Each commissioning region has a unique level of CR uptake and sociodemographic profile. Concurrently, the value case for commissioning CR relies on the upfront cost of the service being offset by long-term healthcare savings, and health improvements.The shift in the UK and internationally to more localised commissioning necessitates evidence of cost-effectiveness that better reflects the realities of those decision makers. This paper provides vital additional data to facilitate such commissioners to understand the value case in increasing CR uptake in line with national policy.

Exercise rehabilitation in COPD and heart failure: comparison of two national audits.

Pulmonary (PR) and cardiac rehabilitation (CR) are recommended in the management of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); the impact of coexisting COPD and CHF on completion and outcomes of rehabilitation programmes is unknown. We examined enrolment, completion and clinical outcomes of CR and PR in adults with COPD, CHF and coexisting COPD and CHF. The National Audit of CR and National COPD Audit Programme: clinical audits of PR were analysed (211 PR and 237 CR programmes); adults with a diagnosis of CHF, COPD or coexisting COPD and CHF were identified (COPD+CHF or CHF+COPD according to database). Propensity matching was conducted (age, sex, body mass index and functional status) between COPD+CHF and COPD, and CHF+COPD and CHF. Group by time interaction was examined using mixed 2×2 analysis of variance. Those with CHF+COPD had lower enrolment and completion of CR compared to those with CHF; there were no differences in PR enrolment or completion between the two groups. Adults with COPD made a significantly larger gain in the incremental shuttle walk test compared to adults with COPD+CHF following PR (59.3 m versus 37.4 m); the improvements following CR were similar (CHF 77.3 m versus CHF+COPD 58.3 m). Similar improvements were made in the 6-min walk test following CR (CHF 45.1 m versus CHF+COPD 38.8 m) and PR (COPD 48.2 m versus COPD+CHF 44.0 m). Comparable improvements in quality of life and mood state were made following CR and PR, regardless of diagnosis. We have demonstrated that multi-morbid adults benefit from exercise-based rehabilitation, yet efforts are needed to promote completion. These findings support group-based, tailored, multi-morbid exercise rehabilitation.

Levels of depressive symptoms in cardiac patients attending cardiac rehabilitation with a history of depression: pre Covid-19 and Covid-19 period comparison

BackgroundThe large-scale changes in cardiac rehabilitation (CR) programme delivery in response to COVID-19 has led to diminished provision. The influence of these service changes on the depression symptoms of patients in CR programmes is unknown. Our study investigated the extent of depressive symptoms prior to and during the COVID-19 periods in patients with a previous history of depression at the start of CR.MethodsUse of Registry routine practice data, National Audit of Cardiac Rehabilitation (NACR), from COVID-19 period Feb 2020 and Jan 2021, as well as pre COVID-19 period Feb 2019 and Jan 2020, was extracted. Depressive symptoms were defined according to Hospital Anxiety and Depression Score ≥ 8. Chi-square tests and independent samples t-tests were used to investigate baseline characteristics. Additionally, a binary logistic regression to examine the factors associated with high levels of depressive symptoms.ResultsIn total 3661 patients with a history of depression were included in the analysis. Patients attending CR during COVID-19 were found to be 11% more likely to have high levels of acute depressive symptoms compared to patients attending CR prior to COVID-19. Physical inactivity, increased anxiety, a higher total number of comorbidities, increased weight, and living in the most deprived areas were statistically significant factors associated with high levels of acute depressive symptoms at the start of CR following multivariate adjustments.ConclusionOur research suggests that following a cardiac event patients with prior history of depression have high levels of acute depressive symptoms at CR baseline assessment. This finding exists in both the pre Covid-19 and Covid-19 periods in patients with a history of depression.

A pragmatic effectiveness-implementation study comparing trial evidence with routinely collected outcome data for patients receiving the REACH-HF home-based cardiac rehabilitation programme

BackgroundCardiac rehabilitation for heart failure continues to be greatly underused worldwide despite being a Class I recommendation in international clinical guidelines and uptake is low in women and patients with mental health comorbidities.MethodsRehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme was implemented in four UK National Health Service early adopter sites (‘Beacon Sites’) between June 2019 and June 2020. Implementation and patient-reported outcome data were collected across sites as part of the National Audit of Cardiac Rehabilitation. The change in key outcomes before and after the supervised period of REACH-HF intervention across the Beacon Sites was assessed and compared to those of the intervention arm of the REACH-HF multicentre trial.ResultsCompared to the REACH-HF multicentre trial, patients treated at the Beacon Site were more likely to be female (33.8% vs 22.9%), older (75.6 vs 70.1), had a more severe classification of heart failure (26.5% vs 17.7%), had poorer baseline health-related quality of life (MLHFQ score 36.1 vs 31.4), were more depressed (HADS score 6.4 vs 4.1) and anxious (HADS score 7.2 vs 4.7), and had lower exercise capacity (ISWT distance 190 m vs 274.7 m). There appeared to be a substantial heterogeneity in the implementation process across the four Beacon Sites as evidenced by the variation in levels of patient recruitment, operationalisation of the REACH-HF intervention and patient outcomes. Overall lower improvements in patient-reported outcomes at the Beacon Sites compared to the trial may reflect differences in the population studied (having higher morbidity at baseline) as well as the marked challenges in intervention delivery during the COVID-19 pandemic.ConclusionThe results of this study illustrate the challenges in consistently implementing an intervention (shown to be clinically effective and cost-effective in a multicentre trial) into real-world practice, especially in the midst of a global pandemic. Further research is needed to establish the real-world effectiveness of the REACH-HF intervention in different populations.

Are patient characteristics and modes of delivery associated with completion of cardiac rehabilitation? A national registry analysis

AimTo achieve effectiveness and reduce inequality in everyday cardiac rehabilitation, this study aims to compare individual patient characteristics along with completion rates to traditional and evolving modes of delivery in cardiac rehabilitation. MethodPatients were included from the UK National Audit of Cardiac Rehabilitation (NACR) database. All patients with coronary heart disease (≥18 years) between the 1st of January 2014 to 31st of December 2019 that started core rehabilitation with a recorded mode of cardiac rehabilitation delivery were eligible. Modes of delivery were divided into: centre-based, home-based, and hybrid. Logistic regression models were used to investigate association between modes of delivery and completion adjusting for patient demographics. ResultIn total 182,722 patients had mode of delivery recorded: 72.8% centre-based, 8.3% home-based and 18.9% hybrid. The home-based mode in comparison to hybrid and centre-based had significantly higher rates of females, single, white, and unemployed patients (p < 0.001). There was a higher proportion of cardiovascular risk factors in home-based than the other modes (p < 0.001). There was a reduced likelihood of completing home-based cardiac rehabilitation compared to centre-based with an odds ratio of 0.66, (95% CI: 0.48 to 0.91) but no significant difference between hybrid and centre-based modes (odds ratio, 1.18; 95% CI 0.92 to 1.51). ConclusionsFrom large real-world data, home-based modes of delivery appear to have significantly lower levels of completion than centre-based modes. Cardiac rehabilitation programs offering home-based and hybrid delivery modes need to be structured to ensure adequacy of completion.

Systematic screening for anxiety and depression in cardiac rehabilitation – are we there yet?

BackgroundAnxiety and depression are prevalent in 20% of patients with acute coronary syndrome (ACS) and associated with poor outcomes. Guidelines recommend screening for these conditions in cardiac rehabilitation (CR) however, clinical practice is inconsistent. Sparse knowledge exists on determinants for screening. MethodsThis observational study used data from the National Audit of Cardiac Rehabilitation from January 2016–December 2019. A multivariate logistic regression model was performed to analyze patient- and provider level determinants for screening for anxiety and depression among patients with ACS. ResultsThe population consisted of 138,018 patients, where 82,507 (59.8%) were screened and 55,511 (40.2%) were not. Younger age, non-white ethnicity, living in areas of social deprivation, current smoking, body mass index>30, and physical activity<150 min per week were negatively correlated with patients being screened. Compared to patients having a percutaneous coronary intervention, patients undergoing coronary artery bypass grafting or medical treatment were less likely to be screened. History of anxiety, depression, osteoporosis, chronic back problems, and asthma were positively correlated with screening, while chronic obstructive pulmonary disease, diabetes, hypertension, and stroke were negatively correlated with screening. Regarding provider level, certification of CR centers was positively associated with screening, while looking over time data showed an incremental negative trend in screening from 2016 to 2019. ConclusionWe found both patient and provider level determinants of screening for anxiety and depression. Clinical practice is still inconsistent especially for high-risk groups. We recommend systematic screening to enable tailored interventions which in turn may mitigate inequity in health outcomes.

To what extent are comorbidity profiles associated with referral and uptake to cardiac rehabilitation

IntroductionGiven the high proportion of comorbidities in patients with coronary heart disease (CHD) and low participation rates in cardiac rehabilitation (CR), a better understanding of how comorbidity interacts with the CR pathway is needed. We investigated associations between comorbidity profiles and referral and uptake in everyday clinical CR across UK. MethodPatients (≥18 years) diagnosed with a CHD between 1st of January 2014 and 31st of December 2019 registered in the National Audit of Cardiac Rehabilitation (NACR) database were eligible. Self-reported comorbidities from 15 disease categories were conceptualized into similar or dissimilar based on overall related pathophysiologic profile and care management as CHD. Regression models were conducted with four comorbidity profiles; similar conditions, dissimilar conditions, similar and dissimilar and no comorbidity. Results399,348 (61.8%) patients were eligible for referral from 198 programmes. The majority were males (70%), mean age of 67 (±12 SD) years. A non-significant association was found between comorbidity profiles and referral. Odds ratios (OR) for CR uptake were higher in patients with dissimilar (OR = 1.38 (95% CI 1.26–1.54)) and dissimilar and similar comorbidities profiles (OR = 1.35 (95% CI 1.21–1.43)) compared to patients with similar comorbidities. No significant differences in uptake were found between patients with similar comorbidities and those without comorbidities (OR = 0.985 (95% CI 0.854–1.125). ConclusionUsing routine practice data, comorbidity profiles were not significantly associated with CR referral suggesting equality in referral. Dissimilar comorbidity profiles were associated with uptake. To increase the likelihood of starting CR, services should consider developing tailored participation strategies that include comorbidity profiles.

Determinants of achieving the minimum clinically important difference for the Incremental Shuttle Walk Test in a cardiac rehabilitation population

Abstract The primary aim of this study was to identify the determinants of achieving the minimum clinically important difference (MCID) for the Incremental Shuttle Walk Test (ISWT) in the CR population. The secondary aim was to examine whether achieving MCID in ISWT at the end of the CR programme is associated with the likelihood of patients meeting the physical activity recommendation or whether it is associated with the patients' self-reported physical fitness (Dartmouth COOP tool) at the end of the CR programmme. Method Routine clinical data related to patients who undertook ISWT as a pre- and post-CR functional capacity assessment were taken from National Audit of Cardiac Rehabilitation (NACR) during the 2013 to 2016 and retrospectively analysed. A sub-analysis was conducted to address the secondary aim. Logistic regression approaches, taking account of potential confounders were constructed. Results For the main study, data from 9,786 patients (mean age of 63.9±10.7), 77.5% of whom were male, were analysed. Sixteen determinants for achieving the MCID for ISWT in CR patients were identified. A sub-analysis was also conducted on 7,950 to address the secondary aim. Patients who achieved the MCID were 30% more likely to meet the physical activity recommendation and 60% more likely to rate themselves positively on the self-reported physical fitness Dartmouth COOP scale. Funding Acknowledgement Type of funding source: None

Predictors of Quitting Smoking in Cardiac Rehabilitation.

Quitting smoking and participation in cardiac rehabilitation (CR) are effective strategies in reducing morbidity and mortality. However, little is known about the predictors of quitting smoking in those who attend CR. This study aimed to determine the sociodemographic and clinical factors associated with the likelihood of CR attendees who are quitting smoking. Data from the UK National Audit of Cardiac Rehabilitation (NACR) database, between April 2013 and March 2016, were used. Smoking status is categorized as smokers and quitters, assessed by patient self-report. The study used patient demographics, cardiovascular risk factors, comorbidities, and physical and psychosocial health measures. Binary logistic regression was performed to identify the predictors of quitting smoking among CR attendees. Of the 3290 patients who started CR and were entered into the NACR database, 2052 were continued smokers (mean age 58.59 ± 10.49 years, 73.6% men) and 1238 were quitters (mean age 57.63 ± 10.36 years, 75.8% men). The median duration of CR was 9 weeks. Compared to smokers, the quitters were younger, weighed more, were less anxious and depressed, and were more likely to be employed. Single patients had 0.60 times lower odds (95% CI 0.43 to 0.82) of quitting smoking than patients with partners, and low-risk patients had 1.71 times higher odds (95% CI 1.12 to 2.62) of quitting smoking than high-risk patients. Increasing number of comorbidities and depression scores were associated with decreasing likelihood of quitting. This study highlights the routine factors that determine smoking cessation outcomes, which could inform the delivery of CR to better help patients to quit smoking.

Discovering solutions to the habit conundrum

British Journal of Cardiac NursingVol. 15, No. 8 EditorialDiscovering solutions to the habit conundrumis corrected byErratumAysha MendesAysha MendesCorrespondence to: E-mail Address: [email protected]MA Healthcare Ltd, London, UKSearch for more papers by this authorAysha MendesPublished Online:26 Aug 2020https://doi.org/10.12968/bjca.2020.0119AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Heart Foundation. National Audit of Cardiac Rehabilitation. 2019. http://www.cardiacrehabilitation.org.uk/about-us.htm (accessed 18 August 2020) Google ScholarClear J. Atomic habits. New York (NY): Random House; 2018 Google Scholar FiguresReferencesRelatedDetailsCited bySupporting cardiac patients during the COVID-19 pandemicSusan Dawkes9 May 2020 | British Journal of Cardiac Nursing, Vol. 15, No. 5Nurses in isolation, and the dark clouds and silver linings revealed by COVID-19Helen Cowan, Lucy Mason, Emma Wilson28 May 2020 | British Journal of Cardiac Nursing, Vol. 15, No. 5Related articlesErratum29 Sep 2020British Journal of Cardiac Nursing 2 August 2020Volume 15Issue 8ISSN (online): 2052-2207 Metrics History Published online 26 August 2020 Published in print 2 August 2020 Information© MA Healthcare LimitedPDF download

Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?

BackgroundPatients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR.MethodsAnalysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population.ResultsThe analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement.ConclusionThe study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.

Evaluation of Cardiac Rehabilitation Performance and Initial Benchmarks for Australia: An Observational Cross-State and Territory Snapshot Study

Australia, unlike most high-income countries, does not have published benchmarks for cardiac rehabilitation (CR) delivery. This study provides cross-state data on CR delivery for initial benchmarks and assesses performance against international minimal standards. A prospective observational study March-May 2017 of CR programs in NSW (n=36), Tasmania (n=2) and ACT (n=1) was undertaken. Data were collected on 11 indicators (published dictionary), then classified as higher or lower performing using the UK National Audit of Cardiac Rehabilitation (NACR) criteria. Equity of access to higher performing CR was assessed using logistic regression. Participants (n=2,436) had a mean age of 66.06±12.54 years, 68.9% were male, 16.2% culturally and linguistically diverse (CALD) and 2.6% Aboriginal and Torres Strait Islander peoples. At patient level, waiting time was median 15 (Interquartile range [IQR] 9-25) days, 24.3% had an assessment before starting, 41.8% on completion, a median 12 sessions (IQR 6-16) were delivered, which 59.1% completed and 75.4% were linked to ongoing care. At program level, using NACR criteria, 18.0% were classified as higher performing and ≥87.1% met waiting time criteria, however, only 20.5% met duration criteria. Evidence of inequitable access to higher performing programs was present with substantially higher odds for participants living in major cities (OR 28.11 95%CI 18.41, 44.92) and with every decade younger age (OR 1.89-2.94) and lower odds by 89.0% for principal referral hospital-based services (OR 0.11 95%CI 0.08, 0.14) and 31.0% for people having a CALD background (OR 0.69 95%CI 0.49, 0.97). This study provides initial national CR performance benchmarks for quality improvement in Australia. While wait times are minimised, few programs are higher performing or met minimum duration standards. There is an urgent need to resource and support CR quality and access outside of major cities, in principal referral hospitals and for older and diverse patients.

Factors influencing the uptake of cardiac rehabilitation by cardiac patients with a comorbidity of stroke

BackgroundCardiac rehabilitation (CR) is an effective complex intervention for people with coronary heart disease (CHD) which promotes healthy lifestyles, improves quality of life and reduces risk factors. Only 50% of UK eligible patients participate in CR, of which 5.3% have a comorbidity of stroke. Literature has identified parallels in aetiology and risk factors of CHD and stroke. Alongside emerging literature on the benefits of CR for stroke patients, this prompted this study to investigate CR uptake in people with comorbidity of stroke. MethodsPatients entered into the National Audit of Cardiac Rehabilitation (NACR) between 1st Jan 2013 and 30th Jan 2019 were included. Analysis included patient- and service-level characteristics identifying factors associated with uptake of CR by people with comorbid stroke using hierarchical logistic regression. Results6,342 patients were included in the final analysis. This subpopulation was comparable with the wider CR and stroke populations. Main patient-level factors included age, ethnicity, deprivation and having a partner. Main service-level factors were presence of a multi-disciplinary team (MDT) and staff hours per patient. ConclusionPatient and service-level factors contributed to the likelihood of a cardiac patient with comorbid stroke attending CR. The patient-level variables are consistent with wider literature on uptake, suggesting different models of delivery need to be explored to meet the population needs. CR programmes with a more comprehensive and well-resourced MDT are more likely to succeed in increasing the patient attendance with comorbidity of stroke. This highlights inequity of provision and requires strategies to overcome and influencing uptake.

To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation?

BackgroundDepression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR.MethodsAn observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic.ResultsThe analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male.ConclusionThe research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.

Prehabilitation and ‘pre'scribing in cardiac care

British Journal of Cardiac NursingVol. 14, No. 8 EditorialPrehabilitation and ‘pre'scribing in cardiac careAysha MendesAysha MendesCorrespondence to: Aysha Mendes Email:E-mail Address: [email protected]Editor, MA Healthcare Ltd, London, UKSearch for more papers by this authorAysha MendesPublished Online:6 Aug 2019https://doi.org/10.12968/bjca.2019.0083AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Arora RC, Brown IC, Sanjanwala RM, McKelvie R. “NEW” prehabilitation: a 3-way approach to improve postoperative survival and health-related quality of life in cardiac surgery patients. Can J Cardiol. 2018;34(7):839–849. https://doi.org/10.1016/j.cjca.2018.03.020 Crossref, Google ScholarBritish Heart Foundation. National Audit of Cardiac Rehabilitation (NACR) quality and outcomes report 2018. 2018. https://www.bhf.org.uk/informationsupport/publications/statistics/national-audit-of-cardiac-rehabilitation-quality-and-outcomes-report-2018 (accessed 25 July 2019) Google ScholarDepartment of Health and Social Care. Advancing our health: prevention in the 2020s – consultation document. 2019. https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document (accessed 25 July 2019) Google ScholarPerry R, Scott LJ, Richards A et al.. Pre-admission interventions to improve outcome after elective surgery—protocol for a systematic review. Syst Rev. 2016;5:88. https://doi.org/10.1186/s13643-016-0266-9 Crossref, Google ScholarRogers J. Prehab. What is it and why do we need it? 2015. https://www.ten.co.uk/prehabilitation/ (accessed 25 July 2019) Google ScholarTang S, McBride S, Potts K. Social prescribing: surely, we are not just going to prescribe tea and biscuits. J Para Pract. 2019;11(7):294–295. https://doi.org/10.12968/jpar.2019.11.7.294 Link, Google ScholarUniversity of Bristol. Prehabilitation: boosting patients' powers of recovery before surgery. 2017. http://www.bristol.ac.uk/cancer/news/2017/prehabilitation.html (accessed 25 July 2019) Google Scholar FiguresReferencesRelatedDetails 2 August 2019Volume 14Issue 8ISSN (online): 2052-2207 Metrics History Published online 6 August 2019 Published in print 2 August 2019 Information© MA Healthcare LimitedPDF download

Determinants of walking fitness in patients with heart failure attending cardiac rehabilitation

IntroductionPatients with heart failure (HF) attending cardiac rehabilitation (CR) benefit in terms of improved quality of life, physical fitness and reduced hospital admissions. Too few patients with HF attend CR...