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12,000 patients miss out on cardiac rehab because of COVID pandemic

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NACR report The NACR report was led by the BHF, the British Association for Cardiovascular Prevention and Rehabilitation, the National Cardiovascular Intelligence Network, NHS England and NHS Improvement, and the Cardiovascular Care Partnership

A new report has found that 12,400 fewer patients participated in cardiac rehabilitation programmes in 2020 than in 2019. The National Audit of Cardiac Rehab (NACR) found that these reductions were down to the redeployment of staff to COVID services. Almost 80% of cardiac rehab programmes across England, Northern Ireland and Wales3 had some or all of their team redeployed from January to December 2020, with 12% of programmes ceasing to run completely.

It’s hugely important that everyone who needs cardiac rehab is able to access it,’ said Professor Patrick Doherty, Director of the NACR report. ‘However, these worrying figures show that people who may need cardiac rehab the most aren’t always attending.’

The implications of not participating in rehab following a cardiac event can be life threatening. Research has shown that such programmes reduce the risk of premature death by a quarter and lowers hospital admissions by around a fifth, it also reduces the chances of a further serious heart-related illness. The report2 showed the greatest fall in participation was among ethnic minority groups, where 11% fewer patients took up cardiac rehabilitation in 2020 compared to 2019.

‘It is concerning to see such a large overall drop, and that ethnic minority groups appear to face disproportionately reduced access to cardiac rehab,’ said Ruth Goss, Senior Cardiac Nurse at the British Heart Foundation (BHF).The reasons for ongoing inequalities in cardiac rehab are complex, and there are multiple reasons why people aren’t attending. One size does not fit all, and if we want more patients to benefit from cardiac rehab, then we need to make it both easy to access and available in a form useful to patients.’

The pandemic also saw a major shift in the way people were accessing cardiac rehabilitation, with home-based delivery now overtaking group delivery as the dominant mode of cardiac rehab. Home-based cardiac rehab only made up 16% of delivery modes prior to the pandemic, but this has increased to 76%.

The NACR report states that, to make sure that those who need cardiac rehab the most are benefitting from it, all modes of service delivery – from home-based to group-based and hybrid versions – are being offered and delivered to national standards.

To help make sure cardiac rehab is being offered to those who need it, the report also recommends that inclusive protocols and checklists are introduced, and proactive steps taken to engage and support patients from underrepresented ethnic groups and those from areas of higher deprivation.


‘Now more than ever cardiac rehab needs to be tailored to the individual’s needs and preferences,’ said Professor Doherty. ‘This includes making sure that everyone who needs it can access it, whether that be in person or online, regardless of their age, gender, ethnicity or socioeconomic background.’



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Comments

The redeployment of specialist cardiac nurses to support the first wave of acute COVID patient admissions was a logical short term measure in order to maintain our critical care services. Without a doubt cardiac rehabilitation plays an essential part in the recovery process of patients who have experienced significant myocardial injury. If Professor Docherty's predictions are correct the UK will experience an additional 3,000 plus early deaths per year as a result of the reduction in rehabilitation programs. The majority of these premature deaths will first experience debilitating and deteriorating health which will require acute interventions and hospital admissions adding to the strain on our available NHS resources. It is my view that cardiac rehabilitation services should be fully reinstated as quickly as reasonably practicable.

Mike Paynter
Consultant Nurse
Somerset
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