Two-thirds of heart attack patients failed to receive a life-saving service, according to a report released by the British Heart Foundation (BHF) today.

The 2009 National Audit of Cardiac Rehabilitation (NACR) (1) found that only 34% of 83,540 heart attack sufferers took part in a cardiac rehabilitation programme. Just 30% of those who underwent an angioplasty procedure and 68% of those who had coronary artery bypass operations received the essential service. Overall the audit found that only 38% of heart patients attended cardiac rehabilitation (2).The audit covered England, Wales and Northern Ireland.

Cardiac rehabilitation gives heart attack patients a 26% greater chance of surviving in the five years following their diagnosis by providing them with the vital skills to manage their condition and significantly improves their quality of life (3).

The NACR, commissioned by the BHF, also found that women were significantly underrepresented in the programme. While women made up 37% of heart attack survivors, only 28% of patients that took part in cardiac rehabilitation were women.

The report indicates the service is falling short of the goals outlined in the National Service Framework for Coronary Heart Disease in England (2000), which set a target for 85% of cardiac patients to be invited to participate in cardiac rehabilitation. There has been no significant increase in the proportion of patients referred to rehabilitation programmes since last year's audit.

Dr Mike Knapton, Associate Medical Director at the BHF, was disappointed with the results.
"The number of heart patients taking part in cardiac rehabilitation hasn't increased since the last report. The audit shows that progress on making this life-saving service available to patients is flat-lining."

"Recovery from a heart attack isn't over when a patient leaves hospital and heart patients should be receiving the ongoing support they need. Referral to cardiac rehabilitation should be a routine part of treating heart patients, and until this happens they will continue to miss out."

In addition, the report did not find a single cardiac rehabilitation programme which met minimum staffing requirements (4). Only 1% of programmes meet the staffing guideline for pharmacy, 8% met the guideline for dieticians and 9% for psychological support.

Professor Bob Lewin at the BHF Cardiac Care and Education Research Group, who wrote the report, said "Patient referral is one of the main reasons why people are not attending. Many patients are simply not aware that it exists or that they should be doing it. "

"It is worrying that a third of patients who were offered the service said they weren't interested. Why wouldn't you be interested in a service that could prolong and improve your life? It is important that all of the staff within the health service understand the benefits of cardiac rehabilitation and communicate how important it is to their patients."

Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. At the end of the programme, patients are able to understand their condition, have greater confidence and are able to regain a high quality of life again (5).

The BHF and British Association for Cardiac Rehabilitation (BACR) are part of the Cardio and Vascular Coalition (CVC), a collaboration of over 40 organisations with an interest in heart and circulatory disease. The CVC is calling on the Westminster Government to commit to a renewed planned approach to cardiovascular conditions, as the National Service Framework for Coronary Heart Disease reaches its 10th anniversary. The CVC recently published Destination 2020 - a voluntary sector vision for change, which highlighted cardiac rehabilitation as a major area of unfinished business, including provision and uptake of cardiac rehabilitation, requiring ongoing prioritisation for the next decade.

Campaigns in Scotland, Wales and Northern Ireland are also asking for specific action by national governments.

Join the campaign for cardiac rehab by going to bhf.org.uk/cardiacrehab.

For a copy of the executive summary click here and for a full copy of the report click here.

Notes

(1) The audit examined data on the provision of cardiac rehabilitation in a 12 month period from 2007 - 2008. Data was collected from England, Wales and Northern Ireland.
(2) 38% of heart attack, angioplasty and coronary artery bypass patients were referred to cardiac rehabilitation.
(3) Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682 - 92.
(4) Guidelines outlined in the Scottish Intercollegiate Guideline Network (2002).
(5) Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. Quality programmes will include:

- ongoing advice and support from medical professionals
- advice on improving lifestyle and diet
- a structured exercise programme
- counselling

At the end of the average 12 week programme, patients will understand their condition, have greater confidence and be able to regain a high quality of life again.
Rehabilitation programmes teach people with heart disease to become more expert and active at self-managing their conditions - an aim which is high on the UK Government's wish list. It is also recommended by NICE (the National Institute for Health and Clinical Excellence).

Source
The British Heart Foundation