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Background: Guidelines recommend referral to cardiac rehabilitation (CR) for cardiac event prevention and risk factor management, but poor attendance persists. Following the development of standardised data and uniform capture, CR services have contributed to three audits in South Australia, Australia. We aimed to determine if CR attendance impacts on cardiovascular readmission, morbidity and mortality.Methods: In a retrospective cohort study, CR databases were linked to hospital administrative datasets to compare the characteristics and outcomes of CR patients between 2013 and 2015. Inverse probability weighting methods were used to measure associations between CR attendance versus non-attendance and cardiovascular readmission and the composite of death, new/re-myocardial infarction, atrial fibrillation, heart failure and stroke within 12-months.Results: Of 49,909 eligible separations, 15,089/49,909 (30.2%) were referred to CR with an attendance rate of 4,286/15,089 (28.4%). Referred/declined patients were older (median: 67.3 vs 65.3 years, p < 0.001), more likely to be female (32.3% vs 26.5%, p < 0.001) with more heart failure (17.1% vs 10.9%, p < 0.001) and arrhythmia (6.1% vs 2.1%, p < 0.001) admissions and higher socio-economic disadvantage (median Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD): 950.1 vs 960.4, p < 0.001). Referred/attended patients had lower cardiovascular readmission, (referred/attended vs not referred: 15.6% vs 22.7% and referred/attended vs referred/declined: 15.6% vs 29.6%, p < 0.001). After clinical and social factors adjustment there was no difference in composite outcomes, but attendance was associated with reduced cardiovascular readmission (HR:0.68, 95% IQR: 0.58-0.81, p = 0.001).Conclusions: Audit can measure service effectiveness, identifying areas for improvement. This study highlights patient eligibility, system and program considerations for future CR services. [ABSTRACT FROM AUTHOR]

Evolution of diagnostic testing modalities in cardiovascular medicine has been rapid. Technological advances in cardiac imaging have enabled the assessment of cardiac texture and function with unprecedented resolution, while the assessment of coronary artery disease by non-invasive means has matured to rival coronary angiography. Similarly, developments in the area of serum biomarkers have given further insights into the risk experienced by patients with coronary artery disease, acute coronary syndromes and heart failure. However, the rate of this innovation calls for a moment''s pause to refocus on the goals of the diagnostic and risk refinement process that is to deliver better care and improve clinical outcome. To date many studies in this area have fallen short of demonstrating such benefits and it is our responsibility as a clinical community to demand more of such innovation. [Copyright &y& Elsevier]

Background: Informed consent is a basic standard of care for all patients undergoing medical procedures, but recall of information has been shown to be poor. We sought to compare verbal, written and animated audiovisual information delivery, during consent for coronary angiography, by measuring improvement in recall. Method: A sample population of 99 cardiac patients at Flinders Medical Centre was randomised (1:1:1) to receive one of three information delivery methods. The information content was standardised by a risk proforma, which explained the procedure and defined 12 specific risks. Recall, satisfaction and anxiety were assessed by a questionnaire administered at three different time points: post-consent, post-procedure and at 30 days. Effect of delivery method on satisfaction and anxiety was rated on a self-reported scale from 1-5, with 5 representing very satisfied or very anxious. Groups were compared by non-parametric testing and a p-value of <0.05 was considered statistically significant. Results: Patients were a median age of 64 (i.q.r. 56, 72) years. Information delivery method had no effect on recall of risks at any time-point (p=0.2, 0.7, 0.5, respectively) and the average recall score across the population was 3-4 out of 12. There was no significant effect on median satisfaction scores: verbal; 5 (i.q.r.4, 5) versus written/audiovisual; 4 (i.q.r.4, 5) (p=ns), or on median anxiety scores: verbal; 3 (i.q.r.2, 4) versus written/audiovisual; 3 (i.q.r.2, 4) (p=ns). Conclusion: Despite careful design of an innovative audiovisual delivery technique aimed at optimising comprehension and aiding memory, recall of information was poor and informational aids showed no improvement. Modes of information delivery are not the key to patient assimilation of complex medical information. [ABSTRACT FROM AUTHOR]

Background: Nursing, allied health and technical personnel are increasingly being recognised as pivotal in the diagnosis and management of heart disease. This recognition is mirrored in research, scholarship and professional development activities. Documenting the evolution and progression of a group''s professional development is a useful strategy in informing future strategic initiatives. Aim: The purpose of this paper is to illustrate the development and participation of the Affiliates group within the Cardiac Society of Australia and New Zealand (CSANZ). Method: Data related to CSANZ membership, participation in the Annual Scientific Meeting as well as the number, type and ranking of abstracts were retrieved from CSANZ records for the period 1995–2003. These data were analysed using descriptive statistics. Results: Since the introduction of the Affiliate member status in 1988, membership has grown steadily, as has participation of members in the governance of the CSANZ. Mean abstract grades of Affiliate members are increasingly comparable with those of the FCSANZ, Ordinary and Associate members. Conclusions: Affiliate members are increasing their profile in the highly competitive environment of the Annual Scientific Meeting, demonstrating the critical role of nursing, allied health and technical professions in cardiovascular health and science. [Copyright &y& Elsevier]

Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. This study aimed to investigate CR utilisation and effectiveness in South Australia. This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23–79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01–1.24; p=0.024), depression (OR 1.17; 95% CI 1.05–1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05–1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31–0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58–0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73–0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has introduced a major disruption to the delivery of routine health care across the world. This provides challenges for the use of secondary prevention measures in patients with established atherosclerotic cardiovascular disease (CVD). The aim of this Position Statement is to review the implications for effective delivery of secondary prevention strategies during the COVID-19 pandemic.Challenges: The COVID-19 pandemic has introduced limitations for many patients to access standard health services such as visits to health care professionals, medications, imaging and blood tests as well as attendance at cardiac rehabilitation. In addition, the pandemic is having an impact on lifestyle habits and mental health. Taken together, this has the potential to adversely impact the ability of practitioners and patients to adhere to treatment guidelines for the prevention of recurrent cardiovascular events.Recommendations: Every effort should be made to deliver safe, ongoing access to health care professionals and the use of evidenced based therapies in individuals with CVD. An increase in use of a range of electronic health platforms has the potential to transform secondary prevention. Integrating research programs that evaluate the utility of these approaches may provide important insights into how to develop more optimal approaches to secondary prevention beyond the pandemic. [ABSTRACT FROM AUTHOR]

Lack of service data for cardiac rehabilitation limits understanding of program delivery, benchmarking and quality improvement. This study aimed to describe current practices, management, utilisation and engagement with quality indicators in Australian programs. Cardiac rehabilitation programs (n=396) were identified from national directories and networks. Program coordinators were surveyed on service data capture, management systems and adoption of published national quality indicators. Text responses were coded and classified. Logistic regression determined independent associates of the use of data for quality improvement. A total of 319 (81%) coordinators completed the survey. Annual patient enrolments/programs were >200 (31.0%), 51−200 (46%) and ≤50 (23%). Most (79%) programs used an electronic system, alongside paper (63%) and/or another electronic system (19%), with 21% completely paper. While 84% knew of the national quality indicators, only 52% used them. Supplementary to patient care, data were used for reports to managers (57%) and funders (41%), to improve quality (56%), support funding (43%) and research (31%). Using data for quality improvement was more likely when enrolments where >200 (Odds ratio [OR] 3.83, 95% Confidence Interval [CI] 1.76−8.34) and less likely in Victoria (OR 0.24 95%, CI 0.08−0.77), New South Wales (OR 0.25 95%, CI 0.08−0.76) and Western Australia (OR 0.16 95%, CI 0.05−0.57). The collection of service data for cardiac rehabilitation patient data and its justification is diverse, limiting our capacity to benchmark and drive clinical practice. The findings strengthen the case for a national low-burden approach to data capture for quality care. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease of 2019 (COVID-19) pandemic significantly disrupted health care, especially outpatient services such as cardiac rehabilitation (CR). We investigated the impact of early COVID-19 waves on the delivery of Australian CR programs, comparing this time period with usual practice prior to the pandemic (2019) and current practice (2021) once the early waves had subsided. Specifically, we aimed to understand how the delivery of programs during COVID-19 compared to usual practice. An anonymous online cross-sectional survey of Australian CR program staff was conducted, comprising three sections: program and respondent characteristics, COVID-19 impact on program delivery, and barriers to, and enablers of, program delivery. Respondents were asked to consider three key timepoints: 1) Pre-COVID-19 (i.e. usual practice in 2019), 2) Early COVID-19 waves (March–December 2020), and 3) Currently, at time of survey completion post early COVID-19 waves (May–July 2021). Of the 314 Australian CR programs, 115 responses were received, of which 105 had complete data, representing a 33% response rate. All states and territories were represented. During early COVID-19 waves programs had periods of closure (40%) or reduced delivery (70%). The majority of programs reported decreased CR referrals (51.5%) and decreased participation (77.5%). The two core components of CR—exercise and education—were significantly impacted during early COVID-19 waves, affecting both the number and duration of sessions provided. Exercise session duration did not return to pre-pandemic levels (53.5 min compared to 57.7 min, p=0.02). The majority of respondents (77%) reported their CR program was inferior in quality to pre-pandemic and more organisational support was required across information technology, staffing, administration and staff emotional and social support. Australian CR programs underwent significant change during the early COVID-19 waves, consistent with international CR reports. Fewer patients were referred and attended CR and those who did attend received a lower dose of exercise and education. It will be important to continue to monitor the long-term impacts of the COVID-19 pandemic to ensure CR programs return to pre-pandemic functioning and continue to deliver services in line with best practice and evidence-based recommendations. [ABSTRACT FROM AUTHOR]

Evolution of diagnostic testing modalities in cardiovascular medicine has been rapid. Technological advances in cardiac imaging have enabled the assessment of cardiac texture and function with unprecedented resolution, while the assessment of coronary artery disease by non-invasive means has matured to rival coronary angiography. Similarly, developments in the area of serum biomarkers have given further insights into the risk experienced by patients with coronary artery disease, acute coronary syndromes and heart failure. However, the rate of this innovation calls for a moment's pause to refocus on the goals of the diagnostic and risk refinement process that is to deliver better care and improve clinical outcome. To date many studies in this area have fallen short of demonstrating such benefits and it is our responsibility as a clinical community to demand more of such innovation. [ABSTRACT FROM AUTHOR]