Improving Cardiac Rehabilitation Uptake: Potential health gains by socioeconomic status

Abstract: Globally cardiac rehabilitation (CR) is recommended as soon as possible after admission from an acute myocardial infarction (MI) or revascularisation, with evidence of its effectiveness identified by repeated robust systematic reviews. However, uptake is consistently poor, ranging from 10% to 60%, which falls well short of national participation targets. The poor level of uptake is compounded by variation across different socioeconomic groups.

Recent policy discussions have focussed on increasing uptake and addressing inequalities in participation rates. However, to date there is a paucity of economic evidence relating to increasing CR rates and an absence of evidence looking at differential impacts of increased uptake by socioeconomic status.

In this paper we construct a de-novo cost-effectiveness model of CR, utilising the results from the latest Cochrane review. We explore the role of socioeconomic status by incorporating key deprivation parameters and determine the population health gains, by socioeconomic status, of achieving the 65% UK uptake target.

We find that the low cost of CR and the potential for reductions in subsequent MI and revascularisation rates combine to make it a highly cost-effective intervention. While CR is less cost-effectiveness for more deprived groups due to a poorer completion rates and underlying health; the lower level of uptake in these groups makes the potential health gains, from achieving the 65% target, greater. Alongside the health gains by group from reaching the target; we estimate the expenditure that could be justified while maintaining the cost-effectiveness of CR, is £68.4 million per year.

We conclude that programmes to increase CR uptake should be designed to reduce the socioeconomic inequalities that exist in uptake. Through the estimation of potential population health gain and justifiable expenditure we have produced tools with which policy makers and commissioners can encourage greater utilisation of CR services.