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1. Assessing the quality of cardiac rehabilitation programs by measuring adherence to the Australian quality indicators

Author

Astley CM, Beleigoli A, Tavella R, Hendriks Gallagher JC, Tirimacco R, Wilson G, Barry T, and Clark RA

Subjects
Accreditation, Quality improvement, Cardiac rehabilitation, Acute coronary syndromes, Coronary heart disease, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Every year, over 65,000 Australians experience an acute coronary syndrome (ACS) and around one-third occur in people with prior coronary heart disease. Cardiac rehabilitation (CR) aims to prevent a repeat ACS by supporting patients’ return to an active and fulfilling lifestyle. CR programs are efficacious, but audits of clinical practice show variability of program delivery, which may compromise patient outcomes. Core components, quality indicators and accreditation of programs have been introduced internationally to increase program standardisation. With Australian quality indicators (QIs) for cardiac rehabilitation recently introduced, we aimed to conduct a survey in one state of Australia to assess the extent to which programs adhere to the measurement of QIs comparing country, metropolitan, telephone and face to face programs. Methods A cross- sectional survey design with face validity testing was used to formulate questions to evaluate cardiac rehabilitation program and personnel characteristics and QI adherence. Between October 2020- December 2021, 23 cardiac rehabilitation programs across country and metropolitan areas were invited to participate. Quality improvement was defined as adherence to the Australian Quality Indicators, and we developed an objective score to calculate program performance categorised by quartiles. Significance of CR completion and time to enrolment between program type (telephone versus face to face) and location (country versus metropolitan were compared using Pearson’s Chi-square and Mann–Whitney U tests. Results Among the 23 CR programs, 15 were country and 8 metropolitan-based and 22 were face to face and 1 telephone-based. Median wait time from discharge was 27.0 days, (interquartile range 19.3–46.0) across all programs and country completions of enrolled were 76.9% versus metropolitan 56.5%, p

Published
2022
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18. Improving Cardiac Rehabilitation Utilisation is Essential to Reducing Mortality and Cardiovascular Readmission: A Data Linkage Analysis of Cardiac Rehabilitation Utilisation and Clinical Outcomes of 84,064 Eligible Separations in South Australia

Author

Beleigoli, A., primary, Foote, J., additional, Gebremichael, L., additional, Bulamu, N., additional, Astley, C., additional, Keech, W., additional, Tavella, R., additional, Gulyani, A., additional, Nesbitt, K., additional, Pinero de Plaza, M., additional, Ramos, J., additional, Ludlow, M., additional, Tideman, P., additional, Nicholls, S., additional, Chew, D., additional, Beltrame, J., additional, and Clark, R., additional

Published
2023
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23. Harmonising Individual Patient Level Cardiac Registry Data Across the Asia Pacific Region—A Feasibility Study of In-Hospital Outcomes of STEMI Patients From the Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Network

Author

Reid, Christopher, Chih, Jun, Duffy, S.J., Brennan, A.L., Ajani, A.E., Beltrame, J., Tavella, R., Yan, B.P., Dinh, D., Chin, C.T., Do, L.D., Nguyen, Q.N., Nguyen, H.T.T., Wijaya, I.P., Yamin, M., Rusdi, L., Alwi, I., Sim, K.H., Yip Fong, A.Y., Wan Ahmad, W.A., Yeo, K.K., Reid, Christopher, Chih, Jun, Duffy, S.J., Brennan, A.L., Ajani, A.E., Beltrame, J., Tavella, R., Yan, B.P., Dinh, D., Chin, C.T., Do, L.D., Nguyen, Q.N., Nguyen, H.T.T., Wijaya, I.P., Yamin, M., Rusdi, L., Alwi, I., Sim, K.H., Yip Fong, A.Y., Wan Ahmad, W.A., and Yeo, K.K.

Abstract

Objective: The Asia-Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration was established to inform on percutaneous coronary intervention (PCI) in the Asia-Pacific Region. Our aims were to (i) determine the operational requirements to assemble an international individual patient dataset and validate the processes of governance, data quality and data security, and subsequently (ii) describe the characteristics and outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing PCI in the ASPECT registry. Methods: Seven (7) ASPECT members were approached to provide a harmonised anonymised dataset from their local registry. Patient characteristics were summarised and associations between the characteristics and in-hospital outcomes for STEMI patients were analysed. Results: Six (6) participating sites (86%) provided governance approvals for the collation of individual anonymised patient data from 2015 to 2017. Five (5) sites (83%) provided >90% of agreed data elements and 68% of the collated elements had <10% missingness. From the registry (n=12,620), 84% were male. The mean age was 59.2±12.3 years. The Malaysian cohort had a high prevalence of previous myocardial infarction (34%), almost twice that of any other sites (p<0.001). Adverse in-hospital outcomes were the lowest in Hong Kong whilst in-hospital mortality varied from 2.7% in Vietnam to 7.9% in Singapore. Conclusions: Governance approvals for the collation of individual patient anonymised data was achieved with a high level of data alignment. Secure data transfer process and repository were established. Patient characteristics and presentation varied significantly across the Asia-Pacific region with this likely to be a major predictor of variations in the clinical outcomes observed across the region.

Published
2023

31. Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors

Author

Beleigoli, A., Gebremichael, L., Bulamu, N., Gulyani, A., Chew, D., Nicholls, S., Ramos, J., Maher, C., Beltrame, J., Kaambwa, B., Versace, V., Hendriks, J., Tavella, R., Foote, J., Nesbitt, K., Powell, S., Pinero de Plaza, M., Keech, W., Ludlow, M., Maeder, A., Wanguhu, K., Meyer, H., Prichard, I., Suebkinorn, O., Zeitz, C., Brown, A., and Clark, R.

Published
2024
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32. Implementation and prospective evaluation of the Country Heart Attack Prevention model of care to improve attendance and completion of cardiac rehabilitation for patients with cardiovascular diseases living in rural Australia: a study protocol

Author

Beleigoli, A, Nicholls, SJ, Brown, A, Chew, DP, Beltrame, J, Maeder, A, Maher, C, Versace, Vincent, Hendriks, JM, Tideman, P, Kaambwa, B, Zeitz, C, Prichard, IJ, Tavella, R, Tirimacco, R, Keech, W, Astley, C, Govin, K, Nesbitt, K, Du, H, Champion, S, Pinero de Plaza, MA, Lynch, I, Poulsen, V, Ludlow, M, Wanguhu, K, Meyer, H, Krollig, A, Gebremichael, L, Green, C, Clark, RA, Beleigoli, A, Nicholls, SJ, Brown, A, Chew, DP, Beltrame, J, Maeder, A, Maher, C, Versace, Vincent, Hendriks, JM, Tideman, P, Kaambwa, B, Zeitz, C, Prichard, IJ, Tavella, R, Tirimacco, R, Keech, W, Astley, C, Govin, K, Nesbitt, K, Du, H, Champion, S, Pinero de Plaza, MA, Lynch, I, Poulsen, V, Ludlow, M, Wanguhu, K, Meyer, H, Krollig, A, Gebremichael, L, Green, C, and Clark, RA

Abstract

IntroductionDespite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%–50% of eligible patients participating. We aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants.Methods and analysisCHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation.Ethics and disseminationThis study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver o

Published
2022

45. Assessing the quality of cardiac rehabilitation programs by measuring adherence to the Australian quality indicators.

Author

CM, Astley, A, Beleigoli, R, Tavella, JC, Hendriks Gallagher, R, Tirimacco, G, Wilson, T, Barry, RA, Clark, Astley, C M, Beleigoli, A, Tavella, R, Hendriks, J, Gallagher, C, Tirimacco, R, Wilson, G, Barry, T, and Clark, R A

Subjects
CARDIAC rehabilitation, TREATMENT programs, MANN Whitney U Test, ACUTE coronary syndrome, CORONARY disease, KEY performance indicators (Management), CLINICAL medicine, QUALITY of life
Abstract

Background: Every year, over 65,000 Australians experience an acute coronary syndrome (ACS) and around one-third occur in people with prior coronary heart disease. Cardiac rehabilitation (CR) aims to prevent a repeat ACS by supporting patients' return to an active and fulfilling lifestyle. CR programs are efficacious, but audits of clinical practice show variability of program delivery, which may compromise patient outcomes. Core components, quality indicators and accreditation of programs have been introduced internationally to increase program standardisation. With Australian quality indicators (QIs) for cardiac rehabilitation recently introduced, we aimed to conduct a survey in one state of Australia to assess the extent to which programs adhere to the measurement of QIs comparing country, metropolitan, telephone and face to face programs.Methods: A cross- sectional survey design with face validity testing was used to formulate questions to evaluate cardiac rehabilitation program and personnel characteristics and QI adherence. Between October 2020- December 2021, 23 cardiac rehabilitation programs across country and metropolitan areas were invited to participate. Quality improvement was defined as adherence to the Australian Quality Indicators, and we developed an objective score to calculate program performance categorised by quartiles. Significance of CR completion and time to enrolment between program type (telephone versus face to face) and location (country versus metropolitan were compared using Pearson's Chi-square and Mann-Whitney U tests.Results: Among the 23 CR programs, 15 were country and 8 metropolitan-based and 22 were face to face and 1 telephone-based. Median wait time from discharge was 27.0 days, (interquartile range 19.3-46.0) across all programs and country completions of enrolled were 76.9% versus metropolitan 56.5%, p < 0.001 and telephone versus face to face 92.9% versus 59.6% p < 0.001. Pre-program QI adherence was higher than post program for depression, medication adherence, health-related quality of life and comprehensive re-assessment. Seventy four percent of programs were ranked at a medium level of performance (mean score: 11.4/16, SD ± 0.79).Conclusions: A survey of 23 cardiac rehabilitation programs, showed variability in adherence to measurement of the Australian Cardiovascular and Rehabilitation Association and Australian Heart Foundation Cardiac Rehabilitation Quality Indicators.Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR), ACTRN12621000222842 , registered 03/03/2021. [ABSTRACT FROM AUTHOR]

Published
2022
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47. 2389Survival after myocardial infarction with non-obstructive coronary arteries (MINOCA) - A comprehensive systematic review and meta-analysis

Author

Pasupathy, S, primary, Lindahl, B, additional, Litwin, P, additional, Tavella, R, additional, Williams, M, additional, Air, T, additional, Marfella, R, additional, Bainey, K, additional, Alzuhairi, K, additional, Reynolds, H, additional, Johnston, N, additional, Kerr, A, additional, and Beltrame, J, additional

Published
2019
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