Review
Australian Cardiovascular Health and Rehabilitation Association (ACRA) Core Components of Cardiovascular Disease Secondary Prevention and Cardiac Rehabilitation 2014

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Background

Research on Australian cardiovascular disease secondary prevention and cardiac rehabilitation to guide practice needs updating to reflect current context of practice. It is timely therefore to review the core components that underpin effective services that deliver maximum benefits for participants.

Methods

The Australian Cardiovascular Health and Rehabilitation Association (ACRA) convened an inter-agency, multidisciplinary, nationally representative expert panel of Australia's leading cardiac rehabilitation clinicians, researchers and health advocates who reviewed the research evidence.

Results

Five core components for quality delivery and outcomes of services were identified and are recommended: 1) Equity and access to services, 2) Assessment and short-term monitoring, 3) Recovery and longer term maintenance, 4) Lifestyle/behavioural modification and medication adherence, and 5) Evaluation and quality improvement.

Conclusions

ACRA seeks to provide guidance on the latest evidence in cardiovascular disease secondary prevention and cardiac rehabilitation. Clinicians should use these core components to guide effective service delivery and promote high quality evidence based care. Directors of hospitals and health services should use these core components to aid decision-making about the development and maintenance of these services.

Introduction

Cardiovascular disease (CVD) is the biggest killer of Australians [1]. A large proportion of these deaths are premature and preventable [1]. Australians in lower socioeconomic groups, Aboriginal and Torres Strait Islander people and those living in remote areas have the highest rates of hospitalisation and death from CVD [2]. There is Level 1, Grade A evidence, defined according to National Health and Medical Research criteria [3], that attendance at cardiovascular disease secondary prevention and cardiac rehabilitation (CR) after a cardiac event decreases morbidity and mortality and improves quality of life [4].

CR is eloquently defined by the World Health Organisation as “the coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their own efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse progression of disease” [5]. Worryingly, equity and access to CR in Australia remains alarming low, with the recent SNAPSHOT study demonstrating that only 47% of eligible patients were documented as referred and that fewer still were discharged on a minimal level of effective secondary prevention [6].

There are barriers to CR participation that are unique to Australia [7]. These include diverse cultural and linguistic needs; a third of Australia's population have emigrated from other countries [8] and transportation logistics associated with a rapidly ageing population [8]. The vast geographical area further complicates CR provision, particularly given the dominance of facility-based CR services [9]. There is clear access disparity between those living in densely populated urban areas and those in the most remote regions of Australia [9]. Specific barriers also exist for Aboriginal and Torres Strait Islander people, including the lack of cultural sensitivity and safety within the Australian health care system and paucity of services designed specifically for their needs [7]. The aims of this paper are to summarise the current evidence for CR with reference to the Australian setting and to establish core components, which should underpin all CR services in Australia.

Section snippets

Material and Methods

The Australian Cardiovascular Health and Rehabilitation Association (ACRA) convened an inter-agency, multidisciplinary, nationally representative expert panel of Australia's leading cardiac rehabilitation clinicians, researchers and health advocates who reviewed the research evidence. A detailed review of national and international guidelines and position statements was undertaken [10], [11], [12], [13]. Core components from the review were drafted and revised iteratively by the writing panel.

Core Components

The core components (Box) for Australian CR services have been grouped into five areas for service delivery.

  • 1.

    Referral and access to services

  • 2.

    Assessment and short-term monitoring

  • 3.

    Recovery and longer term maintenance

  • 4.

    Lifestyle/behavioural modification and medication adherence

  • 5.

    Evaluation and quality improvement

Conclusion

CR services in Australia are diverse. CR services should be tailored to the individual patient's needs and capabilities for participation and in some instances, multiple options made available. ACRA recommends that clinicians working in the field of CVD secondary prevention and CR utilise this core components document, which presents the current evidence base for delivery of CR to inform best practice. ACRA encourages CR providers to adopt the five core components outlined within this statement

Acknowledgements

The 2014 ACRA Executive Management Committee (John Aitken, Jessica Auer, Emma Boston, Paul Camp, Craig Cheetham, Robyn Gallagher, Alun Jackson, Dianna Lynch, Dawn McIvor) who have reviewed and endorsed this document.

Lis Neubeck is an NHMRC early career fellow APP1036763

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