Posted on 22 February 2016
Cardiac rehabilitation (CR) is designed to restore patients to optimal health and prevent premature death and future risk following a cardiac event such as a heart attack. Current national guidance states patients should be seen early and start core CR within four weeks of referral. However, evidence from the British Heart Foundation (BHF) funded National Audit of Cardiac Rehabilitation, which collects information on service provision, patient care and outcome, shows large variation in the timing of CR between centres.
To date it is unclear what the impact of delayed CR, i.e. outside the four week window, might be. To understand whether this is an issue, researchers in the Department of Health Sciences conducted an observational study using data from routine practice, investigating the patient characteristics associated with delayed CR and attempted to determine whether a relationship between CR timing and patient outcome exists.
The study, published in Openheart, looked at physical activity level, quality of life in relation to physical fitness and the incremental shuttle-walk test (a direct measure of fitness) in 32,899 patients attending routine CR across the United Kingdom (UK). Patient characteristics differed between early and late CR attenders. Specifically, late attenders tended to be older females who smoke from non-British backgrounds with other conditions and poor baseline activity levels. In terms of patient improvement following CR, the extent of benefit was also smaller for late CR attenders across all three fitness related outcomes. The analyses found a significant relationship between CR timing and outcome, that is the likelihood of reporting a positive physical activity level and fitness outcome was reduced when CR was delayed.
This is the first large scale, multi-centre analysis which has investigated the effects of delayed CR timing on patient outcomes using routinely collected UK patient data. These results provide evidence that programmes must strive to adhere to recommendations on prompt CR delivery. The principal Investigator, Research Fellow Jennifer Sumner (nee Fell), remarked: “Avoidable delays in practice must be overcome so patients can gain the maximum benefits from cardiac rehabilitative services”.