Key result
Country cardiac rehabilitation programs had significantly higher completion rates than metropolitan programs (76.9% vs 56.5%, p<0.001), while 74% of all programs demonstrated medium adherence to national quality indicators.
Why the study?
Variability in cardiac rehabilitation program delivery may compromise patient outcomes, prompting an assessment of how programs adhere to newly introduced Australian quality indicators across different settings and delivery modes.
Does adherence to Australian Quality Indicators and completion rates differ between country vs metropolitan and telephone vs face-to-face cardiac rehabilitation programs?
Cross-Sectional (n=23)
Yes
Does adherence to Australian Quality Indicators and completion rates differ between country vs metropolitan and telephone vs face-to-face cardiac rehabilitation programs?
Absolute Event Rate: 76.9% vs 56.5%
p-value: p=<0.001
A survey of South Australian cardiac rehabilitation programs revealed moderate adherence to national quality indicators, with significant variability in completion rates based on program location and delivery mode.
Suggests metropolitan program enhancements may boost completion; leaves open causal drivers in this cross-sectional analysis.
BACKGROUND: Every year, over 65,000 Australians experience an acute coronary syndrome (ACS) and around one-third occur in people with prior coronary heart disease. Cardiac rehabilitation (CR) aims to prevent a repeat ACS by supporting patients' return to an active and fulfilling lifestyle. CR programs are efficacious, but audits of clinical practice show variability of program delivery, which may compromise patient outcomes. Core components, quality indicators and accreditation of programs have been introduced internationally to increase program standardisation. With Australian quality indicators (QIs) for cardiac rehabilitation recently introduced, we aimed to conduct a survey in one state of Australia to assess the extent to which programs adhere to the measurement of QIs comparing country, metropolitan, telephone and face to face programs. METHODS: A cross- sectional survey design with face validity testing was used to formulate questions to evaluate cardiac rehabilitation program and personnel characteristics and QI adherence. Between October 2020- December 2021, 23 cardiac rehabilitation programs across country and metropolitan areas were invited to participate. Quality improvement was defined as adherence to the Australian Quality Indicators, and we developed an objective score to calculate program performance categorised by quartiles. Significance of CR completion and time to enrolment between program type (telephone versus face to face) and location (country versus metropolitan were compared using Pearson's Chi-square and Mann-Whitney U tests. RESULTS: Among the 23 CR programs, 15 were country and 8 metropolitan-based and 22 were face to face and 1 telephone-based. Median wait time from discharge was 27.0 days, (interquartile range 19.3-46.0) across all programs and country completions of enrolled were 76.9% versus metropolitan 56.5%, p < 0.001 and telephone versus face to face 92.9% versus 59.6% p < 0.001. Pre-program QI adherence was higher than post program for depression, medication adherence, health-related quality of life and comprehensive re-assessment. Seventy four percent of programs were ranked at a medium level of performance (mean score: 11.4/16, SD ± 0.79). CONCLUSIONS: A survey of 23 cardiac rehabilitation programs, showed variability in adherence to measurement of the Australian Cardiovascular and Rehabilitation Association and Australian Heart Foundation Cardiac Rehabilitation Quality Indicators. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR), ACTRN12621000222842 , registered 03/03/2021.
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Astley et al. (2022) conducted a cross-sectional in Cardiac rehabilitation (n=23). Country location vs. Metropolitan location was evaluated on Program completion rate (p=<0.001). Country cardiac rehabilitation programs had significantly higher completion rates than metropolitan programs (76.9% vs 56.5%, p<0.001), while 74% of all programs demonstrated medium adherence to national quality indicators.
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