Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors

Aim
Implementation and utilisation of innovative cardiac rehabilitation (CR) modes of delivery remain low. We aimed to evaluate the Country Heart Attack Prevention (CHAP) model clinical and implementation outcomes in rural Australia.

Methods
The Model for Large-Scale Knowledge Translation guided the CHAP co-design to address low referrals, delivery options, integration with primary care and CR quality. Using a matched prospective cohort design (n=1,913/group), we compared CR attendance/completion (primary outcomes), cardiovascular (CV) re-admissions, mortality, emergency department (ED) visits through mixed effects models and estimated aggregate healthcare costs between CHAP and usual care.

Results
Attendance was similar (24.2% versus 23.8%, p=0.82; OR 1.15, 95%CI 0.89–1.47; p=0.16) and completion was higher in CHAP (77.1% versus 57.5%, p<0.001; OR 1.69, 95%CI 1.30–2.18; p<0.001). Crude rates were higher but adjusted hazard ratios (HR) did not differ between CHAP and usual care for CV readmission (19.9% versus 16.9%, p<0.001; HR 1.19, 95%CI 0.96–1.49; p=0.17), CV mortality (3.8% versus 1.8%, p<0.001; HR 1.70, 95%CI 0.92–3.16; p=0.09) and ED visits (46.9% versus 42.1%, p<0.001; HR 1.06, 95%CI 0.94–1.21; p=0.33). Cost/attendance ($6,205; 95%CI $6,017–$6,392 versus $5,855, 95%CI $5,730–$5,980) was higher and cost/completion was lower in CHAP ($6,542, 95%CI $6,542-$6,649 versus $8,689, 95%CI $8,573–$8,805). Automatic referrals and data integration were not implemented, which may have contributed to long waiting times (38 days; IQR 23–77).

Conclusions
Person-centred models with choices to patients and integration with primary care can increase CR completion in rural areas. Improvements in attendance, clinical and economic outcomes may need automatic referral systems and shortening of waiting times.