Heart problem: York academics study cardiac rehab shortfall

Researchers at the University of York are trying to discover why so many heart attack victims in the UK fail to take part in potentially life-saving cardiac rehabilitation.

A rehabilitation regime, principally involving lifestyle change, reduces mortality from coronary heart disease but, each year, only about a third of the UK’s 350,000 cardiac patients take advantage of it. The NHS National Service Framework for coronary heart disease says that, by 2002, 80 per cent of people, who have bypass surgery or heart attacks, should have been receiving cardiac rehabilitation. A team from the British Heart Foundation-sponsored Care and Education Group in the University’s Department of Health Sciences will carry out the most comprehensive survey ever mounted into reasons for the generally poor take-up in the 400 rehabilitation centres across the UK.

The five-year study, which has been made possible by a £650,000 grant from the BHF, will be the first national audit to also consider psycho-social factors, such as anxiety, depression and quality of life of patients as well as measuring all the relevant medical variables. Several groups – elderly people, women and people from ethnic minorities – are believed to be under-represented among patients undergoing cardiac rehabilitation while there is a wide disparity in funding, methods and quality of programmes. The seven-strong team, headed by Professor Bob Lewin, will seek to establish best practice to help cardiac rehabilitation centres to improve their overall performance.

Professor Lewin said: “We are trying to find out which centres attract more people and why they are more successful. We will look at the processes they are using and compare these with the outcomes they achieve. This ’process benchmarking’ can give information that no other method could achieve. “The National Service Framework, introduced in 2000, has been very successful in reducing waiting lists for surgery but much less so in getting people into rehabilitation. Data will be collected by clinical staff and fed on line to a dedicated website, operated by the Healthcare Commission. The health professionals working in cardiac rehabilitation will be able to see their results ranked against all the other centres taking part.”

Professor Lewin added: “We will be asking what is the optimum way to run a programme, how many staff are needed and how long rehabilitation should last. The survey will be linked to mortality figures, census data and hospital episode statistics, and eventually, we hope, to surgery and other cardiac datasets. This will yield a picture of the entire patient pathway, for every cardiac patient in the UK, from the acute event to 12 months after their rehabilitation programme.”

Jackie Lodge, Head of Cardiac Care at the BHF said: “At the moment there is little information about the different kinds of help that heart patients receive during cardiac rehabilitation, even though we know that it is often a crucial part of recovery from heart disease. To improve the situation we are delighted to have funded the York team to develop a better picture of cardiac rehabilitation services across the UK and help us shape the best possible care for heart patients.”

In collaboration with the University’s Social Policy Research Unit (SPRU), the Care and Education Research Group has also received £100,000 to evaluate BHF £4.7 million Cardiac Rehab Project supported by the Big Lottery Fund.