Cardiac rehabilitation provides better outcomes for patients
EMBARGOED UNTIL 12.00 NOON SUNDAY 6 OCTOBER 2003
All Australians hospitalised with cardiac conditions should be considered eligible for outpatient cardiac rehabilitation services, according to a study in the Medical Journal of Australia.
Dr Ian Scott, Director of the Clinical Services Evaluation Unit, Princess Alexandra Hospital, Queensland, Kylie Lindsay, from the National Heart Foundation of Australia, and Hazel Harden from Queensland Health Collaborative for Healthcare Improvement found that outpatient cardiac rehabilitation (OCR) programs are underutilised.
"No more than a third of all referred patients completed OCR programs, and only 39 per cent of available OCR program places were fully utilised," said Dr Scott.
Dr Scott and colleagues found that areas serviced by OCR programs with unused places had excess deaths due to coronary heart disease.
Dr Scott stressed that cardiovascular disease remains the leading cause of death in Australia - accounting for 40 per cent of all deaths in 1998.
In addition to coronary heart disease (CHD), many patients with CHD also have suboptimal levels of smoking cessation, physical fitness, blood pressure control and use of cardioprotective medication.
Patients having OCR receive education about diagnosis, medications, risk factors, behaviour modification and symptom management, and most provide an exercise program and psychosocial counselling. Most OCR programs also provide a report to the general practitioner of their patient's participation.
Underutilisation of OCR is attributed to service and patient factors, including lack of awareness by clinicians, inadequate hospital referral procedures, and poor program organisation. From the patient's perspective, competing work commitments, lack of transport and perceptions the programs provided limited value were frequently given as reasons for non-attendance.
In an editorial in the same edition, Dr Stephen Bunker, Manager, National Heart Foundation of Australia, Melbourne, and Dr Alan Goble at the Heart Research Centre, say referrals should be offered to all patients, and the individual needs of each patient considered.
Dr Bunker said that the benefits of OCR programs include reduced mortality and reduced risk of further cardiac events, improvements in physical and social functioning, quality of life, and reduced prevalence of depression. .
"It is clear that a majority of eligible Australians are failing to achieve the potential gains available from our network of outpatient cardiac rehabilitation programs."
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Research - Dr Ian Scott, 07 3240 7355 (w); 07 38788283 (a/h)
Email: ian_scott@health.qld.gov.au
Editorial - Dr Stephen Bunker, 03 9321 1549 (w); 0419 529 671 (a/h)
Email: steve.bunker@heartfoundation.com.au
Judith Tokley, AMA, 0408 824 306