Access to cardiac rehabilitation does not equate to attendance

Background/aims: Timely access to appropriate cardiac care is critical for optimizing outcomes of a cardiac event. In Australia the overall attendance at cardiac rehabilitation remains less than optimal (ranging 37% - 66%). Our aim was to derive an objective, comparable, geographic measure, the Cardiac Accessibility and Remoteness Index of Australia (Cardiac ARIA) reflecting access to cardiac services for all 20,387 population locations. Methods: An expert panel defined a single patient care pathway. Using geographic information systems (GIS) the numeric/alpha index was modeled in two phases. The acute phase (numeric) ranged from 1 (access to tertiary centre with PCI ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The aftercare phase was modeled into 5 alphabetic categories; A (Access to general practitioner, pharmacy, cardiac rehabilitation, pathology ≤1 hour) to E (no services available within 1 hour). Results: Approximately 96% or 19 million people lived within 1 hour of the four basic services to support cardiac rehabilitation and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had no access to any service to support cardiac rehabilitation. Conclusion: Results demonstrated that the majority of Australians had excellent "geographic" access to services to support cardiac rehabilitation and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Innovative clinical practice is needed to improve uptake of this important aspect of cardiac care.