TY - JOUR
T1 - The Impact of Cardiac Rehabilitation and Secondary Prevention Programs on 12-Month Clinical Outcomes
T2 - A Linked Data Analysis
AU - Astley, Carolyn M.
AU - Chew, Derek P.
AU - Keech, Wendy
AU - Nicholls, Stephen
AU - Beltrame, John
AU - Horsfall, Matthew
AU - Tavella, Rosanna
AU - Tirimacco, Rosy
AU - Clark, Robyn A.
N1 - Publisher Copyright:
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
PY - 2020/3
Y1 - 2020/3
N2 - Background: Guidelines recommend referral to cardiac rehabilitation (CR) for cardiac event prevention and risk factor management, but poor attendance persists. Following the development of standardised data and uniform capture, CR services have contributed to three audits in South Australia, Australia. We aimed to determine if CR attendance impacts on cardiovascular readmission, morbidity and mortality. Methods: In a retrospective cohort study, CR databases were linked to hospital administrative datasets to compare the characteristics and outcomes of CR patients between 2013 and 2015. Inverse probability weighting methods were used to measure associations between CR attendance versus non-attendance and cardiovascular readmission and the composite of death, new/re-myocardial infarction, atrial fibrillation, heart failure and stroke within 12-months. Results: Of 49,909 eligible separations, 15,089/49,909 (30.2%) were referred to CR with an attendance rate of 4,286/15,089 (28.4%). Referred/declined patients were older (median: 67.3 vs 65.3 years, p < 0.001), more likely to be female (32.3% vs 26.5%, p < 0.001) with more heart failure (17.1% vs 10.9%, p < 0.001) and arrhythmia (6.1% vs 2.1%, p < 0.001) admissions and higher socio-economic disadvantage (median Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD): 950.1 vs 960.4, p < 0.001). Referred/attended patients had lower cardiovascular readmission, (referred/attended vs not referred: 15.6% vs 22.7% and referred/attended vs referred/declined: 15.6% vs 29.6%, p < 0.001). After clinical and social factors adjustment there was no difference in composite outcomes, but attendance was associated with reduced cardiovascular readmission (HR:0.68, 95% IQR: 0.58–0.81, p = 0.001). Conclusions: Audit can measure service effectiveness, identifying areas for improvement. This study highlights patient eligibility, system and program considerations for future CR services.
AB - Background: Guidelines recommend referral to cardiac rehabilitation (CR) for cardiac event prevention and risk factor management, but poor attendance persists. Following the development of standardised data and uniform capture, CR services have contributed to three audits in South Australia, Australia. We aimed to determine if CR attendance impacts on cardiovascular readmission, morbidity and mortality. Methods: In a retrospective cohort study, CR databases were linked to hospital administrative datasets to compare the characteristics and outcomes of CR patients between 2013 and 2015. Inverse probability weighting methods were used to measure associations between CR attendance versus non-attendance and cardiovascular readmission and the composite of death, new/re-myocardial infarction, atrial fibrillation, heart failure and stroke within 12-months. Results: Of 49,909 eligible separations, 15,089/49,909 (30.2%) were referred to CR with an attendance rate of 4,286/15,089 (28.4%). Referred/declined patients were older (median: 67.3 vs 65.3 years, p < 0.001), more likely to be female (32.3% vs 26.5%, p < 0.001) with more heart failure (17.1% vs 10.9%, p < 0.001) and arrhythmia (6.1% vs 2.1%, p < 0.001) admissions and higher socio-economic disadvantage (median Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD): 950.1 vs 960.4, p < 0.001). Referred/attended patients had lower cardiovascular readmission, (referred/attended vs not referred: 15.6% vs 22.7% and referred/attended vs referred/declined: 15.6% vs 29.6%, p < 0.001). After clinical and social factors adjustment there was no difference in composite outcomes, but attendance was associated with reduced cardiovascular readmission (HR:0.68, 95% IQR: 0.58–0.81, p = 0.001). Conclusions: Audit can measure service effectiveness, identifying areas for improvement. This study highlights patient eligibility, system and program considerations for future CR services.
KW - Cardiovascular rehabilitation
KW - Clinical audit
KW - Clinical effectiveness
KW - Data linkage analysis
KW - Outcomes research
KW - Secondary prevention
UR - http://www.scopus.com/inward/record.url?scp=85065087726&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2019.03.015
DO - 10.1016/j.hlc.2019.03.015
M3 - Article
C2 - 31072769
AN - SCOPUS:85065087726
SN - 1443-9506
VL - 29
SP - 475
EP - 482
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 3
ER -