Carolyn M Astley1, Derek P Chew2, Wendy Keech3, Stephen Nicholls4, John Beltrame5, Matthew Horsfall6, Rosanna Tavella7, Rosy Tirimacco8, Robyn A Clark9. 1. South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia. Electronic address: Carolyn.astley@sahmri.com. 2. Southern Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address: derek.chew@flinders.edu.au. 3. South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia. Electronic address: wendy.keech@sahmri.com. 4. South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia. Electronic address: Stephen.nicholls@sahmri.com. 5. Central Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address: John.beltrame@adelaide.edu.au. 6. Southern Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address: matthew.horsfall@sa.gov.au. 7. Central Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address: Rosanna.tavella@adelaide.edu.au. 8. Integrated Cardiovascular Clinical Network Country Health SA, SA, Australia. Electronic address: rosy.tirimacco@sa.gov.au. 9. Flinders University, Adelaide, SA, Australia. Electronic address: robyn.clark@flinders.edu.au.
Abstract
BACKGROUND: Guidelines recommend referral to cardiac rehabilitation (CR) for cardiac event prevention and risk factor management, but poor attendance persists. Following the development of standardised data and uniform capture, CR services have contributed to three audits in South Australia, Australia. We aimed to determine if CR attendance impacts on cardiovascular readmission, morbidity and mortality. METHODS: In a retrospective cohort study, CR databases were linked to hospital administrative datasets to compare the characteristics and outcomes of CR patients between 2013 and 2015. Inverse probability weighting methods were used to measure associations between CR attendance versus non-attendance and cardiovascular readmission and the composite of death, new/re-myocardial infarction, atrial fibrillation, heart failure and stroke within 12-months. RESULTS: Of 49,909 eligible separations, 15,089/49,909 (30.2%) were referred to CR with an attendance rate of 4,286/15,089 (28.4%). Referred/declined patients were older (median: 67.3 vs 65.3 years, p < 0.001), more likely to be female (32.3% vs 26.5%, p < 0.001) with more heart failure (17.1% vs 10.9%, p < 0.001) and arrhythmia (6.1% vs 2.1%, p < 0.001) admissions and higher socio-economic disadvantage (median Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD): 950.1 vs 960.4, p < 0.001). Referred/attended patients had lower cardiovascular readmission, (referred/attended vs not referred: 15.6% vs 22.7% and referred/attended vs referred/declined: 15.6% vs 29.6%, p < 0.001). After clinical and social factors adjustment there was no difference in composite outcomes, but attendance was associated with reduced cardiovascular readmission (HR:0.68, 95% IQR: 0.58-0.81, p = 0.001). CONCLUSIONS: Audit can measure service effectiveness, identifying areas for improvement. This study highlights patient eligibility, system and program considerations for future CR services.
BACKGROUND: Guidelines recommend referral to cardiac rehabilitation (CR) for cardiac event prevention and risk factor management, but poor attendance persists. Following the development of standardised data and uniform capture, CR services have contributed to three audits in South Australia, Australia. We aimed to determine if CR attendance impacts on cardiovascular readmission, morbidity and mortality. METHODS: In a retrospective cohort study, CR databases were linked to hospital administrative datasets to compare the characteristics and outcomes of CR patients between 2013 and 2015. Inverse probability weighting methods were used to measure associations between CR attendance versus non-attendance and cardiovascular readmission and the composite of death, new/re-myocardial infarction, atrial fibrillation, heart failure and stroke within 12-months. RESULTS: Of 49,909 eligible separations, 15,089/49,909 (30.2%) were referred to CR with an attendance rate of 4,286/15,089 (28.4%). Referred/declined patients were older (median: 67.3 vs 65.3 years, p < 0.001), more likely to be female (32.3% vs 26.5%, p < 0.001) with more heart failure (17.1% vs 10.9%, p < 0.001) and arrhythmia (6.1% vs 2.1%, p < 0.001) admissions and higher socio-economic disadvantage (median Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD): 950.1 vs 960.4, p < 0.001). Referred/attended patients had lower cardiovascular readmission, (referred/attended vs not referred: 15.6% vs 22.7% and referred/attended vs referred/declined: 15.6% vs 29.6%, p < 0.001). After clinical and social factors adjustment there was no difference in composite outcomes, but attendance was associated with reduced cardiovascular readmission (HR:0.68, 95% IQR: 0.58-0.81, p = 0.001). CONCLUSIONS: Audit can measure service effectiveness, identifying areas for improvement. This study highlights patient eligibility, system and program considerations for future CR services.
Authors: Julie Redfern; Robyn Gallagher; Adrienne O'Neil; Sherry L Grace; Adrian Bauman; Garry Jennings; David Brieger; Tom Briffa Journal: Front Cardiovasc Med Date: 2022-04-27
Authors: Jason H Wasfy; Michael K Hidrue; Jacqueline Ngo; Varsha K Tanguturi; Elizabeth T Cafiero-Fonseca; Ryan W Thompson; Natalie Johnson; Susan T McDermott; Jagmeet P Singh; Marcela G Del Carmen; Timothy G Ferris Journal: Circ Cardiovasc Qual Outcomes Date: 2020-05-12
Authors: C M Astley; A Beleigoli; R Tavella; J Hendriks; C Gallagher; R Tirimacco; G Wilson; T Barry; R A Clark Journal: BMC Health Serv Res Date: 2022-02-28 Impact factor: 2.908
Authors: Alline Beleigoli; Stephen J Nicholls; Alex Brown; Derek P Chew; John Beltrame; Anthony Maeder; Carol Maher; Vincent L Versace; Jeroen M Hendriks; Philip Tideman; Billingsley Kaambwa; Christopher Zeitz; Ivanka J Prichard; Rosanna Tavella; Rosy Tirimacco; Wendy Keech; Carolyn Astley; Kay Govin; Katie Nesbitt; Huiyun Du; Stephanie Champion; Maria Alejandra Pinero de Plaza; Imelda Lynch; Vanessa Poulsen; Marie Ludlow; Ken Wanguhu; Hendrika Meyer; Ali Krollig; Lemlem Gebremichael; Chloe Green; Robyn A Clark Journal: BMJ Open Date: 2022-02-16 Impact factor: 3.006