Assessing the quality of cardiac rehabilitation programs by measuring adherence to the Australian quality indicators

Abstract

Background Every year, over 65,000 Australians experience an acute coronary syndrome (ACS) and around one-third occur in people with prior coronary heart disease. Cardiac rehabilitation (CR) aims to prevent a repeat ACS by supporting patients’ return to an active and fulfilling lifestyle. CR programs are efficacious, but audits of clinical practice show variability of program delivery, which may compromise patient outcomes. Core components, quality indicators and accreditation of programs have been introduced internationally to increase program standardisation. With Australian quality indicators (QIs) for cardiac rehabilitation recently introduced, we aimed to conduct a survey in one state of Australia to assess the extent to which programs adhere to the measurement of QIs comparing country, metropolitan, telephone and face to face programs. Methods A cross- sectional survey design with face validity testing was used to formulate questions to evaluate cardiac rehabilitation program and personnel characteristics and QI adherence. Between October 2020- December 2021, 23 cardiac rehabilitation programs across country and metropolitan areas were invited to participate. Quality improvement was defined as adherence to the Australian Quality Indicators, and we developed an objective score to calculate program performance categorised by quartiles. Significance of CR completion and time to enrolment between program type (telephone versus face to face) and location (country versus metropolitan were compared using Pearson’s Chi-square and Mann–Whitney U tests. Results Among the 23 CR programs, 15 were country and 8 metropolitan-based and 22 were face to face and 1 telephone-based. Median wait time from discharge was 27.0 days, (interquartile range 19.3–46.0) across all programs and country completions of enrolled were 76.9% versus metropolitan 56.5%, p < 0.001 and telephone versus face to face 92.9% versus 59.6% p < 0.001. Pre-program QI adherence was higher than post program for depression, medication adherence, health-related quality of life and comprehensive re-assessment. Seventy four percent of programs were ranked at a medium level of performance (mean score: 11.4/16, SD ± 0.79). Conclusions A survey of 23 cardiac rehabilitation programs, showed variability in adherence to measurement of the Australian Cardiovascular and Rehabilitation Association and Australian Heart Foundation Cardiac Rehabilitation Quality Indicators. Trial registration Australia New Zealand Clinical Trials Registry (ANZCTR), ACTRN12621000222842, registered 03/03/2021.

Impact of Early COVID-19 Waves on Cardiac Rehabilitation Delivery in Australia: A National Survey

“…Interestingly however, the collection of quality-of-life data had a non-significant increase from the pre-COVID timepoint to time of survey completion for both program commencement and completion data collection ( Supplementary Table 3 ). This is in opposition to another recent South Australian study, which demonstrated that the health-related quality-of-life quality indicator was the least-measured indicator [ 20 ]. It is possible that CR clinicians in our national sample were more aware of quality of life and thus the value of collecting this data.…”

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

“…had coronary heart disease or chronic heart failure (NYHA I, II, and III). This is consistent with cardiac rehabilitation eligibility criteria reported by Australian programs [ 27 ].…”

“…Our model’s control group aimed to reflect current Australian practice for centre-based cardiac rehabilitation. We used a recently conducted study to determine the length and number of sessions per week in Australian practice [ 27 ]. The study reported that patients had, on average, ten cardiac rehabilitation sessions.…”

Correction to: Assessing the quality of cardiac rehabilitation programs by measuring adherence to the Australian quality indicators

“…Following publication of the original article [ 1 ], the authors identified two errors in the author names. Firstly, the two co-authors’ names J Hendriks and C Gallagher were mistakenly merged into one name ‘Hendriks Gallagher JC’.…”