National Certification Programme for Cardiovascular Rehabilitation – aiming to improve practice

Cardiovascular disease (CVD) continues to be a leading cause of mortality and morbidity in the United Kingdom.1 It is also a leading contributor to health inequalities; reducing excess deaths from coronary heart disease in the most deprived fifth of areas would have the greatest impact on the life expectancy gap in England.2 Cardiovascular rehabilitation (CR) is a multifaceted secondary prevention programme which aims to improve outcomes for people with CVD, with strong evidence of clinical and cost-effectiveness,3 and is recommended by the National Institute for Health and Care Excellence (NICE).4,5 The evidence-based service standards for delivery6,7 include centre or home-based options (equally effective8), by a multidisciplinary team supported by community services (such as smoking cessation). The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) recommends that a CR programme should be based on seven components which have health behaviour change and education at their core (Figure 1). Quality assurance of CR delivery is monitored, assessed and findings published, annually, by the British Heart Foundation–funded National Audit of Cardiac Rehabilitation (NACR) based at the University of York. The NACR collects both programme and patient-level data from a majority of CR programmes across most of the United Kingdom (with the exception of Scotland). To ensure data security and quality, NACR data are hosted by NHS Digital

Factors influencing change in walking ability in patients with heart failure undergoing exercise-based cardiac rehabilitation

OBJECTIVES: Exercise-based cardiac rehabilitation (CR) is an effective intervention for patients with heart failure (HF), in which one of the main targets is to increase physical capacity. In the HF population this is traditionally assessed using distance covered during a walking test. This study aims to establish the extent to which change in walking ability, in HF patients attending CR, is determined by patient characteristics and service provision. METHODS: The study utilised routine clinical data from the National Audit of Cardiac Rehabilitation to perform a robust analysis. Change, in metres, between pre- and post-CR six-minute walk tests was calculated. Multivariate linear regression models were used to explore the relationship between patient characteristics, service-level variables, and change in metres walked. RESULTS: Complete and valid data from 633 patients was analysed, and a mean change of 51.30 m was calculated. Female gender (-34.13 m, p = 0.007), being retired (-36.41 m, p = 0.001) and being married/in a relationship (-32.54 m, p = 0.023) were all significant negative predictors of change. There was an additional negative relationship with body mass index (BMI) whereby for every unit increase in BMI, predicted change reduces by 2.48 m (p = 0.006). CONCLUSIONS: This study identified significant patient-level characteristics strongly associated with limited improvement in walking ability following CR. Improving physical capacity is a core component of CR, therefore services should aim to account for baseline characteristics identified in this study as part of tailoring the CR intervention around the individual. Pre- and post-CR physical capacity assessments, which constitute minimum standards for CR, are worryingly low and should be given high priority