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Evidence-based guidelines recommend cardiac rehabilitation(CR) for secondary prevention of recurrent myocardial infarction(re-MI) and risk factor management, but poor referral and completion rates persist. Regular audit can measure the effectiveness of services. A 2011 audit of public CR services, by the South Australian Department of Health CR Clinical Network showed a 12% program attendance rate. Following development of standardised minimum data and uniform electronic data capture, 24 CR services have contributed within 3 audits. We aimed to link referral and attendance with administrative data to assess characteristics and outcomes of eligible patients. Methods: The CR patient database for 2013-2015 was linked to patients discharged alive with a primary cardiac-related diagnosis and/or interventional procedure, identified through public hospital administrative data. Outcomes were defined as readmission for cardiovascular causes and death captured through the Births Deaths and Marriages database. Patient categories were not referred, referred/declined and attended CR. Associations with cardiovascular readmission and composites of death, new/re-MI, heart failure, atrial fibrillation and stroke over the 12-month follow-up duration were reported using inverse probability weighted survival methods among those who attended and those referred/declined. Results: Of 49,909 eligible cardiac separations, referral rate was 15,089/49,909 (30.2%) and attendance 4,286/15,089 (28.4%). Those referred/declined 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% v 2.1%, P< 0.001) admissions, ≥2 comorbidities (35.3% v 23.3%, P< 0.001), with higher socio-economic disadvantage (median IRSAD: 950.1 vs 960.4, p<0.001). Attending patients had lower cardiovascular readmission, (attended vs not referred: 27.3% vs 34.5% and attended vs referred/declined ; 27.3% vs 41.4%, P< 0.001). After clinical and social factors adjustment there was no difference in composite clinical outcomes to 12-months, but attendance was associated with reduced cardiovascular readmission (HR:0.68, 95% IQR: 0.58-0.81, P = 0.001). Conclusions: This analysis highlights the complexity of factors that influence referral, non-attendance and attendance to CR. Conducting clinical audit and reporting to services is vital for measuring program effectiveness and can be a mechanism for service improvement. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. Methods: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. Results: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. Conclusions: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care. [ABSTRACT FROM AUTHOR]