Case study

Improving uptake and quality of cardiac rehabilitation

Through large-scale studies, our researchers examined how cardiac rehabilitation services could be improved.

Nurse checking a patient's blood pressure

The issue

Every year, tens of thousands of patients miss out on evidence-based cardiac rehabilitation and prevention services. These services are known to enhance life expectancy, reduce unplanned hospital admissions and improve quality of life.

Of the patients who do take up these services, many are receiving poor quality treatment and enduring long waits. Lengthy waiting times are known to reduce the benefits of services in comparison to timely service delivery.

National Institute for Health and Care Excellence (NICE) guidance and international systematic reviews have highlighted the work that needs to be done, but little has happened in terms of system-level service change over the last ten years.

Our health services research sought to change this situation for the benefit of patients and the NHS.

The research

University of York researchers Professor Patrick Doherty and Alexander Harrison, Department of Health Sciences, and Dr Laura Bojke and Sebastian Hinde, Centre for Health Economics, carried out a series of large-scale studies working with data from the British Heart Foundation's (BHF) National Audit of Cardiac Rehabilitation (NACR).

The research set out to establish the extent of the influence of waiting times and timely cardiac rehabilitation on physical fitness as well as psychological and cardiovascular outcomes using routine clinical data.

These studies also investigated wider social determinants of cardiovascular health and service uptake, such as social deprivation. The researchers used routine clinical practice data alongside systematic review evidence to develop a new health economic model evaluating the potential health gains of cardiac rehabilitation. This research was funded by grants from BHF Strategy and the National Institute for Health Research.

The outcome

Our research has directly led to improved service quality through the development of a national certification programme for cardiac rehabilitation (NCP_CR). 

Since this programme was introduced, cardiac rehabilitation quality has improved by an average of 31.7 per cent across the UK, and 13 per cent more patients (13,908) have a tailored programme informed by baseline assessment. Treatment duration has improved to nine weeks, which is one week above clinical minimum standards.

Improved service quality and outcomes through early cardiac rehabilitation are evidenced by a reduction in patient wait times of 18.5 days since 2014.

This research has informed national clinical standards and NHS England's Cardiovascular Disease Outcomes Strategy. It has also been used to aid decision making as part of the NHS Long Term Plan and BHF Strategy.

Patient choice has also been enhanced through our interactive web page, which allows patients to make informed choices based on the quality of local services.

Featured researcher

Patrick Doherty

Professor Doherty's research interests are in cardiac rehabilitation, cardiovascular disease prevention and exercise. His commitment to cardiovascular disease prevention and rehabilitation led to his appointment as NHS Clinical Lead for Cardiac Rehabilitation where he supported service innovation in the NHS.

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Featured researcher

Alexander Harrison

Alexander Harrison is a statistician with a background in biological sciences, which includes experimental research in oesophageal cancer. He has experience in a range of research designs including observational, randomised control trials and systematic reviews.

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