Standards and core components for cardiovascular disease prevention and rehabilitation

Abstract

In 2017, the British Association for Cardiovascular Prevention and Rehabilitation published its official document detailing standards and core components for cardiovascular prevention and rehabilitation. Building on the success of previous editions of this document (published in 2007 and 2012), the 2017 update aims to further emphasise to commissioners, clinicians, politicians and the public the importance of robust, quality indicators of cardiac rehabilitation (CR) service delivery. Otherwise, its overall aim remains consistent with the previous publications—to provide a precedent on which all effective cardiovascular prevention and rehabilitation programmes are based and a framework for use in assessment of variation in service delivery quality. In this 2017 edition, the previously described seven standards and core components have both been revised to six, with a greater focus on measurable clinical outcomes, audit and certification. The principles within the updated document underpin the six-stage pathway of care for CR, and reflect the extensive evidence base now available within the field. To help improve current services, close collaboration between commissioners and CR providers is advocated, with use of the CR costing tool in financial planning of programmes. The document specifies how quality assurance can be facilitated through local audit, and advocates routine upload of individual-level data to the annual British Heart Foundation National Audit of Cardiac Rehabilitation, and application for national certification ensuring attainment of a minimum quality standard. Although developed for the UK, these standards and core components may be applicable to other countries.

Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II)

“…One of the major strengths of this study is its robust approach to CR intervention aligned with published national CR standards and core components. 5 – 7 Our strict definition of a comprehensive multicomponent CR underscores the importance of the amount of physical exercise provided, the adherence to exercise intervention and the adherence to non-exercise components on the patients’ prognosis. The results of recently published meta-analyses (some of them including studies of the modern era of novel medication and interventions) seem to support this approach and somehow elucidate our results.…”

“…reduced all-cause mortality after ACS and after CABG). 4 However, with CROS it became apparent that minimal requirements for CR delivery (based on published standards and core components) 5 – 8 had to be fulfilled to reach effectiveness. These minimal requirements have been addressed by other recent meta-analyses 9 – 13 with a focus on the volume and intensity of exercise sessions and treatment of cardiovascular risk factors during CR.…”

The Stanford Hall consensus statement for post-COVID-19 rehabilitation

“…43 44 The British Association for Cardiovascular Prevention and Rehabilitation specify the following six core components for CR: health behaviour change and education, lifestyle risk factor management, psychosocial health, medical risk management, long-term strategies and audit and evaluation. 43 CR is now recommended in international guidelines, with increasing evidence that CR can improve exercise capacity, QoL, psychological well-being as well as reduce mortality, morbidity and unplanned hospital admissions. [43][44][45][46][47] Formal CR programmes usually begin several weeks or months after the cardiac event.…”

“…43 CR is now recommended in international guidelines, with increasing evidence that CR can improve exercise capacity, QoL, psychological well-being as well as reduce mortality, morbidity and unplanned hospital admissions. [43][44][45][46][47] Formal CR programmes usually begin several weeks or months after the cardiac event. The process starts much earlier with education, protection, mobilisation and reassurance.…”

Heartbeat: Improving acute myocardial infarction outcomes in women

“…In addition, there is an excellent review article8 summarising the standards and core components for cardiovascular disease prevention and rehabilitation (figure 4). …”