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Outpatient cardiac rehabilitation: are the potential benefits being realised?
N C Campbell1, J M Grimshaw, L D Ritchie
1Department of General Practice, University of Aberdeen.
Objective:
to give a comprehensive description of the practice of outpatient cardiac rehabilitation in Scotland.
Design:
an identifying survey of 1,270 individuals in hospital, general practice and community sources nationally, followed by computer-assisted telephone interviews about programme characteristics with key personnel from identified cardiac rehabilitation schemes.
Outcome Measures:
patient provision, referral criteria and programme features.
Results:
65 programmes provided outpatient cardiac rehabilitation for 4,980 patients in one year, representing 17% of the 29,180 patients who survived admission to hospital with coronary heart disease. Cardiac rehabilitation practice varied widely: 53 (82%) programmes included exercise, although only 19 (29%) at the most beneficial level; 40 (62%) included relaxation training, although only three (5%) at a level shown to give benefit; 47 (72%) included education, although only 16 (25%) in a manner with reported benefits in randomised trials.
Conclusions:
outpatient cardiac rehabilitation was provided to a minority of patients with coronary heart disease. Programmes varied widely, and were often more limited than those reporting mortality and morbidity benefits in randomised trials. There is a substantial gap between current provision and practice of cardiac rehabilitation and that advocated in published guidelines.