Cardiac rehabilitation helps people live as full a life as possible following a heart event, surgery or diagnosis.
Cardiac rehab is a programme of exercise, education and psychological support. It helps individuals to address lifestyle changes, understand their heart health, maintain physical activity and look after their emotional wellbeing.
Cardiac rehab has been shown to reduce hospital admissions, lower deaths from cardiovascular disease, reduce the risk of further cardiovascular events and improve quality of life.
The BHF funds the National Audit of Cardiac Rehabilitation (NACR), which collects anonymised data from 90,000 patients in England, Northern Ireland and Wales, and produces an annual report on how services are performing.
Below are the key themes and statistics from the NACR data and other sources.
Boosting uptake
Growth in uptake of cardiac rehab has stalled in recent years. Each year, there are tens of thousands of missed opportunities to encourage people to attend cardiac rehab and help them to maintain a healthy lifestyle.
In England, we have a long way to go to reach the 85% uptake target for 2028 set by NHS England. The uptake rate in Wales is 61% and Northern Ireland is at 49%. Data from Scotland is not available.
Programmes must innovate in how they deliver cardiac rehab to boost uptake.
Unequal access
Women are less likely to attend cardiac rehab than men.
In addition, people from deprived areas are much less likely to attend than those in less deprived areas.2
Cardiac rehab programmes must have a range of options so that they are accessible to everyone.
Ensuring access for everyone
Among people who have a myocardial infarction (MI), those who do not undergo surgery are far less likely to attend cardiac rehab than those who do.
That means 30,000 people had an MI without surgery in 2017/8 and missed the opportunity to attend cardiac rehab.
Tailored to heart failure patients
Only 15% of people who are hospitalised for heart failure are referred for cardiac rehab.3 NICE guidelines recommend that everyone with the condition should be referred if they are stable enough.4
When people with heart failure miss out on cardiac rehab, they are left at even higher risk of being readmitted to hospital or having further heart problems.5
Cardiac rehab providers must innovate to tailor programmes to the needs of people with heart failure.
Delivering rehab digitally
Only a small proportion of patients accessed cardiac rehab courses online in 2017/18.
Offering more patients the opportunity to access cardiac rehab digitally could mean:
- more patients participate in and complete cardiac rehab.
- waiting times are reduced.
- healthcare professionals spend less time delivering sessions and can focus on people with more complex needs.
NACR 2019 findings and recommendations
NACR is a BHF strategic project supporting cardiovascular prevention and rehab services to achieve the best possible outcomes for people with cardiovascular disease, irrespective of where they live.
The statistics shown above are taken from the NACR Quality and Outcomes Report 2019 unless otherwise stated.
The audit, funded by the BHF and hosted by the University of York, collects anonymised data from 90,000 patients in England, Northern Ireland and Wales. It gives a comprehensive picture of who takes part in, and the quality of, cardiac rehabilitation programmes.
Key recommendations from the 2019 report are:
- Optimise recruitment of post-MI patients to CR.
- Ensure patient comorbidity is taken into account as part of CR recruitment, assessment and tailoring of interventions.
- Offer greater innovation in recruiting and managing patients with HF
- Recruit more female patients across all condition/treatment groups.
- Pursue quality CR delivery evidenced by achieving ‘certified’ programme status.
Download previous reports:
References
- Dalal HM, Doherty P, Taylor RS (2015) Cardiac rehabilitation. BMJ 2015;351:h5000
- National Audit of Cardiac Rehabilitation Quality and Outcomes Report 2018
- NICOR National Heart Failure Audit 2023
- NICE (2016) Chronic heart failure in adults, Quality statement 6: Programme of cardiac rehabilitation
- Long L, Mordi IR, Bridges C, et al (2019) Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD003331. DOI: 10.1002/14651858.CD003331.pub5