Cardiac rehabilitation services in England and Wales: a national survey

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Abstract

We sent a short postal questionnaire to 244 centres in England and Wales that admitted patients with cardiac conditions. In total, 199 (81%) of the centres claimed to provide a cardiac rehabilitation service. Of these, 25 were randomly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services. Most (18 (72%)) of the centres had commenced their rehabilitation programme within the previous 5 years, usually at the instigation of interested staff. Patient entry to cardiac rehabilitation programmes was restricted; women (who represented only 15% of attenders), elderly people (excluded in 10 (40%) centres), and those with more complex problems, such as angina or heart failure, were under-represented. The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision. Most (22 (88%)) programmes were hospital out-patient based, one (4%) was hospital in-patient based, one (4%) was community-based and one (4%) was home-based. The staffing and funding of programmes was variable, with 7 (28%) having no identified funding. There are wide variations in the resources currently available for the rehabilitation of patients with coronary heart disease. There is a need for clearer direction of these services, in particular to determine minimum service provision. Guidelines are necessary to give a framework for this relatively new and rapidly expanding service.

Introduction

Cardiac rehabilitation is an expanding adjunct to traditional cardiac care. Though its value has not been evaluated fully there is sufficient evidence available to demonstrate benefits [1], such as an earlier and speedier recovery, and around a 20% reduction in overall mortality 2, 3. In a recent report, the Audit Commission [4]noted that though the value of cardiac rehabilitation has recently received increased recognition from both clinicians and service managers, and it is a relatively inexpensive form of care, it remains a neglected area. Indeed, little is known about the provision of cardiac rehabilitation services in the UK. The purpose of this survey was to determine the level of such provision in England and Wales. The British Cardiac Society 5, 6has undertaken two postal surveys of cardiac rehabilitation programmes, essentially to determine uptake, but this is the first survey of centres claiming to provide cardiac rehabilitation and to examine in detail such provision.

Section snippets

Methods

In January 1994, a brief postal questionnaire was sent to the senior nurse of 244 centres in England and Wales identified by The Directory of Emergency and Special Care Units 1993 as admitting patients with cardiac conditions. The questionnaire sought basic information on the provision of cardiac rehabilitation services: whether the centre provided a cardiac rehabilitation programme; the name, job title and telephone number of the coordinator; and the number of patients provided with the

Results

The 25 centres selected were visited by the researcher between April 1994 and August 1994. Each visit lasted about 4 h. Most of the information sought was immediately available, although some centres later forwarded this by post.

Discussion

In recent years enthusiasm and support for cardiac rehabilitation has grown markedly. The benefits it confers convinces many health care staff that it should form an integrated part of comprehensive cardiac care. The general belief in the benefits of cardiac rehabilitation is reflected in the escalating number of cardiac rehabilitation programmes found in this and other surveys conducted in the UK 5, 6. Recent editorials in the medical press have bolstered such a view and encouraged a

Conclusions

There is a wide range in the provision of cardiac rehabilitation services in England and Wales. Variations in the structure, content, organisation, coordination, staffing and funding of programmes and facilities are evident. The central components of all programmes are education and exercise training, and no centre provides a service comparable with the type of comprehensive programme commonly described in the literature. The quality of service specification needs to be improved with more

Acknowledgements

This survey was part of a study funded by the Department of Health.

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