Does cardiac rehabilitation need a rebrand?
Cardiac rehabilitation attendance in the UK has improved in recent years, but half of eligible people still don’t attend. BHF Director of Healthcare Innovation, Jacob West, asks whether it is time for a rebrand.
21 November 2018, by Jacob West
The UK has made great strides towards getting people to attend cardiac rehabilitation, and increasing the uptake rate over the last five years is a success we should celebrate.
But it’s not enough, because half of all patients eligible for cardiac rehabilitation don’t take it up. The cardiac rehabilitation community must come together to solve the problem of poor attendance, and it’s possible a rebrand could be a part of the solution.
We know cardiac rehabilitation reduces the risk of someone dying from heart and circulatory disease, having another cardiac event such as a heart attack or needing to be readmitted to hospital.
Patients receive vital support in addressing both physical and psychological factors to improve their quality of life in the long term.
Put simply, cardiac rehabilitation saves lives.
But this message isn’t getting through to all those who are eligible. If it was, 63,800 people wouldn’t have missed out on cardiac rehabilitation in 2015-16.
We must learn from other nations in order to improve our uptake rates. The UK is falling short of Lithuania, which has an uptake rate of 90%1, Belgium, at 71%2; and Denmark, whose uptake rate is over 70%3.
We know that women are less likely to take up cardiac rehabilitation: emerging evidence from the upcoming National Audit of Cardiac Rehabilitation Quality and Outcomes Report 2018 has found that only 29% of participants are female.
What’s more, only one in five participants are from a non-white ethnic background. And patients from deprived areas are much less likely to take up and complete cardiac rehabilitation.
We need to ensure that every single patient who has a heart event or undergoes heart surgery is offered CR to help them return to as high a standard of health as possible.
So what can we do differently? To encourage more people to attend cardiac rehabilitation programmes we’re going to have to reach out to them in new ways.
We know that adopting a variety of approaches to offering cardiac rehabilitation boosts attendance rates. Home-based programmes such as REACH-HF, and web-based programmes like Care 4 Today in Buckinghamshire and Activate your Heart in Leicestershire are successful at getting more patients through the door.
But could we go further? There are many avenues to explore – such as wearable technology and ‘gamification’ such as scoring points to motivate positive behaviour change, or investigating the best places for people to receive this intervention, whether at home, in hospitals, or a community setting – to develop a more person-centred approach to cardiac rehab.
Combined models of rehabilitation with other non-communicable diseases such as stroke and respiratory conditions could also provide an opportunity for innovation.
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Two-thirds of patients who don’t attend cardiac rehabilitation say they’re not interested. It’s possible we need to market the service differently, in a way that is more likely to capture their attention and motivate them to attend.
There’s an appetite for change in how we talk about cardiac rehab. The term ‘rehabilitation’ might not appeal to all patients due to the connotations it carries. Is there a need to promote this as an opportunity for ‘recovery’ or ‘rehabilitation and prevention’ instead?
We need to signal that while cardiac rehabilitation helps people to recover from a heart event, their surgery, or helps them manage their heart failure, it’s also a springboard for a wider change that will benefit them throughout their lives. Cardiac rehabilitation should provide a model for how to live well as we get older.
The cardiac rehabilitation community has a brilliant platform from which to innovate. It is time we use this opportunity to learn from one another and make the case for change.
By thinking differently, we can encourage more patients to take up this life-saving service.
Jacob West is Director of Healthcare Innovation at the British Heart Foundation
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1. European Association of Preventative Cardiology. Country of the month – Belgium
2. European Association of Preventative Cardiology. Country of the month – Denmark
3. European Association of Preventative Cardiology. Country of the month – Lithuania