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

A. Beleigoli; L. Gebremichael; N. Bulamu; A. Gulyani; D. Chew; S. Nicholls; J. Ramos; C. Maher; J. Beltrame; B. Kaambwa; V. Versace; J. Hendriks; R. Tavella; J. Foote; K. Nesbitt; S. Powell; M. Pinero de Plaza; W. Keech; M. Ludlow; A. Maeder; K. Wanguhu; H. Meyer; I. Prichard; O. Suebkinorn; C. Zeitz; A. Brown; R. Clark

doi:10.1016/j.hlc.2024.06.209

Abstract

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.

Original language	English
Pages (from-to)	S226-S227
Number of pages	2
Journal	Heart Lung and Circulation
Volume	33
Issue number	Supplement 4
DOIs	https://doi.org/10.1016/j.hlc.2024.06.209
Publication status	Published - Aug 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 10 Reduced Inequalities
SDG 17 Partnerships for the Goals

Keywords

Clinical Effectiveness
Implementation
Evaluation
Large-Scale Translation
Co-Designed Model
Cardiac Rehabilitation
Attendance and Completion
Rural
Person-centred
referral systems

Access to Document

10.1016/j.hlc.2024.06.209Licence: In Copyright

1 Active

safe@home: effectiveness and cost effectiveness of telemonitoring and virtual care supported by primary care for people living with chronic disease in low socioeconomic neighbourhoods for reducing ambulance ramping, readmission and GP clinic block.
Clark, R. (Chief Investigator (Project Lead)), Kaambwa, B. (Chief Investigator), Cleland, J. (Chief Investigator), Inglis, S. (Chief Investigator), Tirimacco, R. (Chief Investigator), Maddison , J. (Chief Investigator), George, S. (Chief Investigator), Tideman, P. (Chief Investigator), Beleigoli, A. (Chief Investigator), Bulamu, N. B. (Chief Investigator), Chaudry, A. (Associate Investigator), Gulyani, A. (Associate Investigator), Pinero de Plaza, M. A. (Associate Investigator), Morton, E. (Associate Investigator), Dawes, N. (Associate Investigator), Briggs, J. (Associate Investigator), Lyon-Green, J. (Associate Investigator), Tallboy, T. (Associate Investigator), Taylor, A. (Associate Investigator) & Okonjo, B. (Associate Investigator)
1/05/23 → 30/04/27
Project: Research

6 Article
4 Poster
2 Meeting Abstract
2 Review article
More
- 1 Abstract
- 1 Other contribution

Implementation of Evidence-Based, Person-Centered Alternative Delivery Models for Cardiac Rehabilitation in a Rural and Remote Population: The Country Heart Attack Prevention (CHAP) Project
Beleigoli, A., Pinero de Plaza, M. A., Gebremichael, L. G., Bulamu, N., Guyliani, A., Chew, D. P., Nicholls, S. J., Ramos, J. S., Maher, C., Beltrame, J., Kaambwa, B., Versace, V. L., Hendriks, J. M., Tavella, R., Foote, J., Nesbitt, K., Powell, S., Keech, W., Ludlow, M. & Maeder, A. & 8 others, Wanguhu, K., Meyer, H., Prichard, I., Suebkinorn, O., Zeitz, C., Brown, A., Clark, R. A. & On behalf of the NHMRC CHAP Project Team, Sept 2026, In: Heart, Lung and Circulation. 35, 9, 11 p., 1337–1347.
Research output: Contribution to journal › Article › peer-review

Open Access
File
1 Citation (Scopus)
Exploring the Fundamentals of Care Framework through a Predictive Model: Insights from a Pilot Study in Australian Healthcare Settings
Pinero de Plaza, M. A., Allande Cusso, R., Conroy, T., Porcel-Gálvez, A. M., Feo, R., Chipchase, L., Adams, A. M. N., Parr, J. & Kitson, A., 16 Jun 2025. 2 p.
Research output: Contribution to conference › Abstract › peer-review

Open Access
Health System Evaluation, Rewired: health professional behaviours
Pinero de Plaza, M. A., 16 Apr 2025, Springer Nature.
Research output: Other contribution › peer-review

Open Access

ACvA CV Champion
Pinero de Plaza, M. A. (Recipient), 29 Aug 2022
Prize: Other distinction

File
Awarded the People's Choice Poster Award at the South Australian Cardiovascular Research Network (SA CVRN) Emerging Leaders Symposium 2026.
Pinero de Plaza, M. A. (Recipient), 24 Jul 2026
Prize

File
A winner of the Big Ideas video competition to improve the Australian health system. Consumer Health Forum of Australia, 2021.
Pinero de Plaza, A. (Recipient), 23 Feb 2021
Prize: Other distinction

File

5 Invited talk
1 Consultancy
1 Other

Global Impact and Recognition of the PROLIFERATE_AI Method
Pinero de Plaza, M. A. (Participant), Lambrakis, K. (Participant), Marmolejo Ramos, F. (Participant), Beleigoli, A. (Participant), Archibald, M. (Participant), Yadav, L. (Participant), McMillan, P. (Participant), Clark, R. (Participant), Lawless, M. (Participant), Morton, E. (Participant), Hendriks, J. (Participant), Kitson, A. (Participant), Visvanathan, R. (Participant), Chew, D. (Participant) & Javier Barrera Causil, C. (Participant)
Jan 2025 → Mar 2025
Activity: Other activity types › Other
Aged & Extended Care Unit Academic Meeting - Monday 17/2/25: Advancing Human-Centred AI in Emergency Care: A Multimethod Evaluation of RAPIDx AI Using the PROLIFERATE_AI Framework
Pinero de Plaza, M. A. (Speaker)
17 Feb 2025
Activity: Talk or presentation types › Invited talk

File
A Human-Machine Evaluation of AI in Cardiac Emergencies
Pinero de Plaza, M. A. (Invited speaker), Lambrakis, K. (Speaker), Marmolejo Ramos, F. (Speaker), Beleigoli, A. (Speaker), Kitson, A. (Speaker), McMillan, P. (Speaker), Chew, D. (Speaker), Clark, R. (Speaker), Lawless, M. (Speaker), Morton, E. (Speaker), Archibald, M. (Speaker), Visvanathan, R. (Speaker), Yadav, L. (Speaker), Hendriks, J. (Speaker) & Javier Barrera Causil, C. (Speaker)
11 Jun 2024
Activity: Talk or presentation types › Invited talk

Cite this

Beleigoli, A., Gebremichael, L., Bulamu, N., Gulyani, A., Chew, D., Nicholls, S., Ramos, J., Maher, C., Beltrame, J., Kaambwa, B., Versace, V., Hendriks, J., Tavella, R., Foote, J., Nesbitt, K., Powell, S., Pinero de Plaza, M., Keech, W., Ludlow, M., ... Clark, R. (2024). Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors. Heart Lung and Circulation, 33(Supplement 4), S226-S227. https://doi.org/10.1016/j.hlc.2024.06.209

@article{9db2779315b24bf381b465dc0f6a2976,

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

abstract = "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.",

keywords = "Clinical Effectiveness, Implementation, Evaluation, Large-Scale Translation, Co-Designed Model, Cardiac Rehabilitation, Attendance and Completion, Rural, Person-centred, referral systems",

author = "A. Beleigoli and L. Gebremichael and N. Bulamu and A. Gulyani and D. Chew and S. Nicholls and J. Ramos and C. Maher and J. Beltrame and B. Kaambwa and V. Versace and J. Hendriks and R. Tavella and J. Foote and K. Nesbitt and S. Powell and \{Pinero de Plaza\}, M. and W. Keech and M. Ludlow and A. Maeder and K. Wanguhu and H. Meyer and I. Prichard and O. Suebkinorn and C. Zeitz and A. Brown and R. Clark",

year = "2024",

month = aug,

doi = "10.1016/j.hlc.2024.06.209",

language = "English",

volume = "33",

pages = "S226--S227",

journal = "Heart Lung and Circulation",

issn = "1443-9506",

publisher = "Elsevier Ltd.",

number = "Supplement 4",

}

Beleigoli, A, Gebremichael, L , Bulamu, N , Gulyani, A , Chew, D, Nicholls, S, Ramos, J, Maher, C, Beltrame, J, Kaambwa, B, Versace, V, Hendriks, J, Tavella, R, Foote, J, Nesbitt, K, Powell, S, Pinero de Plaza, M, Keech, W, Ludlow, M, Maeder, A, Wanguhu, K, Meyer, H, Prichard, I , Suebkinorn, O, Zeitz, C, Brown, A & Clark, R 2024, 'Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors', Heart Lung and Circulation, vol. 33, no. Supplement 4, pp. S226-S227. https://doi.org/10.1016/j.hlc.2024.06.209

Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors. / Beleigoli, A.; Gebremichael, L.; Bulamu, N. et al.
In: Heart Lung and Circulation, Vol. 33, No. Supplement 4, 08.2024, p. S226-S227.

Research output: Contribution to journal › Meeting Abstract › peer-review

TY - JOUR

T1 - Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors

AU - Beleigoli, A.

AU - Gebremichael, L.

AU - Bulamu, N.

AU - Gulyani, A.

AU - Chew, D.

AU - Nicholls, S.

AU - Ramos, J.

AU - Maher, C.

AU - Beltrame, J.

AU - Kaambwa, B.

AU - Versace, V.

AU - Hendriks, J.

AU - Tavella, R.

AU - Foote, J.

AU - Nesbitt, K.

AU - Powell, S.

AU - Pinero de Plaza, M.

AU - Keech, W.

AU - Ludlow, M.

AU - Maeder, A.

AU - Wanguhu, K.

AU - Meyer, H.

AU - Prichard, I.

AU - Suebkinorn, O.

AU - Zeitz, C.

AU - Brown, A.

AU - Clark, R.

PY - 2024/8

Y1 - 2024/8

N2 - 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.

AB - 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.

KW - Clinical Effectiveness

KW - Implementation

KW - Evaluation

KW - Large-Scale Translation

KW - Co-Designed Model

KW - Cardiac Rehabilitation

KW - Attendance and Completion

KW - Rural

KW - Person-centred

KW - referral systems

U2 - 10.1016/j.hlc.2024.06.209

DO - 10.1016/j.hlc.2024.06.209

M3 - Meeting Abstract

SN - 1443-9506

VL - 33

SP - S226-S227

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

IS - Supplement 4

ER -

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

Abstract

UN SDGs

Keywords

Access to Document

Fingerprint

Projects

Research output

Prizes

Activities

Cite this