Search

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]

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]