Cardiac rehabilitation in England: a detailed national survey

AIMS: The purpose of this study is to conduct a detailed analysis of cardiac rehabilitation programmes in England to compare actual provision with the recommendations of the National Service Framework and Scottish Intercollegiate Guideline Network guidelines. METHODS: Questionnaires and interviews were conducted with key staff from one centre in each Strategic Health Authority in England to establish staffing levels, patient throughput, programme details, data collection and funding. RESULTS: There were major discrepancies between programmes and the national recommendations. Perceptions of the service were often at variance within key staff in the trust. Staffing levels, lack of facilities and space were identified as a weakness in many of the programmes. Inadequate exercise sessions, poor record keeping and a failure to tailor the sessions to the patients needs were common. Mean funding was pound288 per patient rehabilitated. CONCLUSIONS: For those 30% of eligible patients who enter cardiac rehabilitation in England, the service suffers from inadequate staffing, facilities and space, associated with gross underfunding. If the recommended 85% of eligible patients were included the situation would be much worse. The Department of Health recommendations for cardiac rehabilitation have not been translated into action, with most hospitals giving it low priority compared with other cardiology services. A treatment with demonstrable benefits should at least meet the standards recommended by national guidelines.