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Cardiovascular Health 2020

Does cardiac rehabilitation need rehabilitating?

photo credit: getty images / Rawpixel

Professor Susan Dawkes

President, British Association for Cardiovascular Prevention and Rehabilitation

Cardiac rehabilitation is know to reduce deaths from cardiovascular disease and help people live healthier, happier and longer lives; yet only half of those who are referred actually attend.

Cardiac rehabilitation in context

As few as one in seven women will attend cardiac rehabilitation. Attendance rates are low in certain patient groups, such as those with heart failure, which means patients are missing out on vital support. These figures, from the National Audit of Cardiac Rehabilitation, are concerning given that the NHS Long Term Plan sets out a challenging target to increase uptake to 85% by 2028. Group-based rehabilitation continues to be the most commonly used method, but if every patient who was eligible did attend, there would not be enough space for everyone in the UK.

Many people are unsure what cardiac rehabilitation involves, or they think it is merely exercise classes and consider it ‘not for them’. More needs to be done to ensure it is understood that it consists of several components, including lifestyle risk-factor management to lessen the chances of the heart disease worsening and support for psychological health. Marketing of cardiac rehabilitation, therefore, needs to improve otherwise the uptake targets will never be achieved. World Heart Day is a time in the year when much publicity is given to cardiovascular-related topics and so it is a helpful time to highlight the importance for people to participate in cardiac rehabilitation, to ensure they get the support to have a longer and better quality of life.

New approaches

The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) indicates that patients should have their needs assessed and an individualised plan for cardiac rehabilitation should be developed and implemented. That said, there is limited benefit in assessing patients individually, then offering a generic cardiac rehabilitation programme (which can happen); one size does not fit all. Not everyone will want group based rehabilitation and so greater use of other, less commonly-used approaches, such as home and web-based, should be offered routinely to patients, to allow for personal choice. These newer approaches are as effective as group-based rehabilitation. Not all services offer these and there was previously some reluctance to do so, however, during the COVID-19 pandemic, many cardiac rehabilitation services, literally overnight, changed to home and web-based rehabilitation, since group activity was not possible. Offering choice may improve uptake and it is right to ensure patients have options.

Other patients may benefit

Traditionally, cardiac rehabilitation services provide support for patients after heart attack, heart surgery (heart valve replacement and coronary artery bypass) and those who have had ‘balloon intervention’ (coronary angioplasty) to widen their heart arteries and relieve angina symptoms. Other groups of patients may also benefit such as those with congenital heart disease and people, mainly women, who suffer spontaneous coronary artery dissection (a tear in the wall of the heart artery). These people are often younger (less than 50 years old) and so differ from the traditional group of patients who access rehabilitation. Little is known of how effective cardiac rehabilitation is in helping them to live well for longer and so, more research is needed. It is essential, though, that commissioners recognise the need to include these other groups of patients and adequately fund cardiac rehabilitation services accordingly. These patients deserve the support that cardiac rehabilitation provides.

The future of cardiac rehabilitation

Cardiac rehabilitation needs to be marketed better, to increase people’s understanding of what is involved and to increase participation, to ultimately improve patients’ lives. The way it is delivered needs to be individualised and offer true patient choice. Contemporary cardiac rehabilitation should be more inclusive of all patients who have cardiovascular disease, as all will benefit. The time has come to rehabilitate cardiac rehabilitation.

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