Cardiac Rehabilitation Quality in Australia: Proposed National Indicators for Field-Testing

Comprehensive exercise-based cardiac rehabilitation (CR) has well-established efficacy and effectiveness for improving patients' outcomes [1,2]. However, delivery of CR programs varies substantially [3] and these beneficial results are only achieved by high performing programs that include most guideline-recommended components. CR programs that assess and address multiple risk factors (six or more) or oversee prescription and monitoring of cardioprotective medications reduce all-cause mortality (27% and 65% respectively), whereas programs that do not include such components have no effect on these outcomes [3]. Moreover, CR programs that monitor, promote and achieve high levels of exercise adherence by participants reduce all-cause and cardiovascular mortality (19% and 28% respectively), in contrast to the lack of effect of CR programs that have suboptimal exercise participation [4].

Assessment of quality plays a major role in achieving guideline-recommended standards. Most high-income countries conduct regular national-level assessment of the quality of CR delivery, including the United Kingdom [5], United States of America [6], Canada [7], Sweden [8] and many other European countries [9]. Australia is the exception. Cardiac rehabilitation quality assessment efforts in Australia currently provide only pieces of the jigsaw puzzle of the real world delivery of CR and include one-off national email-based surveys [10,11] and state-based audits [[12], [13], [14]]. A contributing factor to the lack of a unified assessment of CR quality is the use of inconsistent and diverse quality indicators (QI) for CR. A set of nationally-agreed, internationally-consistent, locally-relevant QIs is urgently needed. This priority was confirmed as the first essential step in improving the monitoring of CR across Australia at a Think Tank led by the Australian Cardiovascular Health and Rehabilitation Association (ACRA) and the National Heart Foundation of Australia (NHFA) and initiated and hosted by the South Australian Advanced Health Research and Translation Centre in September 2018