National database at the heart of the matter

Massey University Research

Cardiovascular disease is the number one killer in New Zealand, accounting for 30% of all deaths annually. But a new survey shows that there is a wide variety in cardiac rehabilitation services with little information on the impact of the different models.

The survey was funded by the Heart Foundation and the New Zealand Cardiovascular Prevention and Rehabilitation Group and conducted by researchers from Massey Universitys College of Health. It revealed that one in four of 42 service providers did not regularly audit their services. This was despite guidelines recommending six-monthly audits to ensure services are on track with patient needs, and to monitor patient outcomes.

A report on the survey is calling for a national database of information to be established.

National database

It says this would give a comprehensive view of service provision and patient outcomes to assess efficacy, with the aim of learning from services that are performing most strongly and strengthening the quality of others.

Research team leader Dr Geoff Kira, from the Research Centre for Mori Health and Development at Massey, says a national database of cardiac rehabilitation services would ensure consistency of quality care measures, as well as identify areas where more funding and services might be needed.

The survey was undertaken because of the poor understanding of the mix and make-up of existing CR [cardiac rehabilitation] programmes across New Zealand and their alignment with evidence-based guidelines.

Of 46 cardiac rehabilitation services nationwide, 86 per cent completed the survey. Results showed the programmes vary in duration from one day to 12 weeks, with an average of six weeks. Half of the services provide a weekly session. Cardiac rehabilitation is delivered in three phases: inpatient and outpatient rehabilitation, and long-term health maintenance.

Areas of interest

Survey questions probed the following areas: structure of the units and services provided; available resources and employees; inclusion and exclusion criteria; and how services meet the needs of under-represented groups. It also asked about programme format and content, session frequency, locations, assessments and referral processes, as well as quality assurance including recording of attendance, and monitoring of outcomes for the third phase of rehabilitation. Research assistant Grace Humphrey, a Bachelor of Sport and Exercise (Exercise Prescription and Training), developed the draft survey, prepared the online survey tool, and followed up cardiac rehabilitation service unit

As well as variations in content and delivery of cardiac rehabilitation, the report found there was also no clear standardised process guiding patient assessment, despite guidelines encouraging assessments and re-assessments in nutrition (dietetic support), smoking status, social support and anxiety or depression, as well as pre-exercise risk.

It is uncertain whether the diversity is due to patient need or an effect of environmental influences, for example, policy and funding, the reports authors said.

Heart Foundations Heart Healthcare Manager Kim Arcus said that cardiac rehabilitation is a vital part of recovery for heart attack patients, and hence charity was keen to support this research.

Cardiac rehab services in New Zealand work really hard and are doing the best with what they have. Were actually quite comfortable with the fact that theres an element of variety in the way programmes are being delivered. However, wed like to see much more consistency in the way outcomes are measured, he said.

A national database would allow us to measure results and then compare those results to find out whats working best. Services could learn from each other and adapt to achieve the best outcomes for patients.

Global research

International research has found that attending cardiac rehabilitation improves health outcomes, so uptake and attendance data should be deemed essential, the report adds. Standardising and centralising unit and patient data would create an accurate profile of regional differences in service provision and this would give important understandings of how these might be linked to patient outcomes.

Dr Kira said that a nationally coordinated cardiac rehabilitation service registry such as in Europe and Britain, and being called for in Australia would help with government policy and decision-making.

Essentially it comes back to maximising the precious health dollar for the benefit of patients and their families, no matter where they live, he says. Cardiac rehab has a major role to play in getting patients back to participating in a meaningful life, whether returning to work, playing sport or being able to help out in their family or community.

Caption: Bachelor of Health Science student Grace Humphreys with Dr Geoff Kira.

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