Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

Alline Beleigoli; Jonathon Foote; Lemlem G. Gebremichael; Norma B. Bulamu; Carolyn Astley; Wendy Keech; Rosanna Tavella; Aarti Gulyani; Katie Nesbitt; Maria Alejandra Pinero de Plaza; Joyce S. Ramos; Marie Ludlow; Stephen J. Nicholls; Derek P. Chew; John Beltrame; Robyn A. Clark

doi:10.1016/j.hlc.2024.01.018

Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

Alline Beleigoli, Jonathon Foote, Lemlem G. Gebremichael, Norma B. Bulamu, Carolyn Astley, Wendy Keech, Rosanna Tavella, Aarti Gulyani, Katie Nesbitt, Maria Alejandra Pinero de Plaza, Joyce S. Ramos, Marie Ludlow, Stephen J. Nicholls, Derek P. Chew, John Beltrame, Robyn A. Clark

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

57 Downloads (Pure)

Abstract

Background: Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation.

Aim: This study aimed to investigate CR utilisation and effectiveness in South Australia.

Methods: This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression.

Results: Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23–79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01–1.24; p=0.024), depression (OR 1.17; 95% CI 1.05–1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05–1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31–0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58–0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73–0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001).

Conclusions: Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.

Original language	English
Pages (from-to)	1036-1045
Number of pages	10
Journal	Heart Lung and Circulation
Volume	33
Issue number	7
Early online date	5 Mar 2024
DOIs	https://doi.org/10.1016/j.hlc.2024.01.018
Publication status	Published - Jul 2024

Keywords

Cardiac rehabilitation
Clinical audit and effectiveness
Quality improvement

Access to Document

10.1016/j.hlc.2024.01.018Licence: CC BY

Final published versionFinal published version, 891 KBLicence: CC BY

Cite this

Beleigoli, A., Foote, J., Gebremichael, L. G., Bulamu, N. B., Astley, C., Keech, W., Tavella, R., Gulyani, A., Nesbitt, K., Pinero de Plaza, M. A., Ramos, J. S., Ludlow, M., Nicholls, S. J., Chew, D. P., Beltrame, J., & Clark, R. A. (2024). Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021). Heart Lung and Circulation, 33(7), 1036-1045. https://doi.org/10.1016/j.hlc.2024.01.018

@article{b8e8b5f1879e4e2684ac7e95b4cbdcc7,

title = "Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)",

abstract = "Background: Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. Aim: This study aimed to investigate CR utilisation and effectiveness in South Australia. Methods: This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. Results: Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23–79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01–1.24; p=0.024), depression (OR 1.17; 95% CI 1.05–1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05–1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31–0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58–0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73–0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). Conclusions: Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.",

keywords = "Cardiac rehabilitation, Clinical audit and effectiveness, Quality improvement",

author = "Alline Beleigoli and Jonathon Foote and Gebremichael, {Lemlem G.} and Bulamu, {Norma B.} and Carolyn Astley and Wendy Keech and Rosanna Tavella and Aarti Gulyani and Katie Nesbitt and {Pinero de Plaza}, {Maria Alejandra} and Ramos, {Joyce S.} and Marie Ludlow and Nicholls, {Stephen J.} and Chew, {Derek P.} and John Beltrame and Clark, {Robyn A.}",

year = "2024",

month = jul,

doi = "10.1016/j.hlc.2024.01.018",

language = "English",

volume = "33",

pages = "1036--1045",

journal = "Heart Lung and Circulation",

issn = "1443-9506",

publisher = "Elsevier Australia",

number = "7",

}

Beleigoli, A, Foote, J, Gebremichael, LG , Bulamu, NB , Astley, C, Keech, W, Tavella, R, Gulyani, A , Nesbitt, K , Pinero de Plaza, MA , Ramos, JS, Ludlow, M, Nicholls, SJ, Chew, DP, Beltrame, J & Clark, RA 2024, 'Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)', Heart Lung and Circulation, vol. 33, no. 7, pp. 1036-1045. https://doi.org/10.1016/j.hlc.2024.01.018

Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021). / Beleigoli, Alline; Foote, Jonathon; Gebremichael, Lemlem G. et al.
In: Heart Lung and Circulation, Vol. 33, No. 7, 07.2024, p. 1036-1045.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge

T2 - Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

AU - Beleigoli, Alline

AU - Foote, Jonathon

AU - Gebremichael, Lemlem G.

AU - Bulamu, Norma B.

AU - Astley, Carolyn

AU - Keech, Wendy

AU - Tavella, Rosanna

AU - Gulyani, Aarti

AU - Nesbitt, Katie

AU - Pinero de Plaza, Maria Alejandra

AU - Ramos, Joyce S.

AU - Ludlow, Marie

AU - Nicholls, Stephen J.

AU - Chew, Derek P.

AU - Beltrame, John

AU - Clark, Robyn A.

PY - 2024/7

Y1 - 2024/7

N2 - Background: Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. Aim: This study aimed to investigate CR utilisation and effectiveness in South Australia. Methods: This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. Results: Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23–79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01–1.24; p=0.024), depression (OR 1.17; 95% CI 1.05–1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05–1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31–0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58–0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73–0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). Conclusions: Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.

AB - Background: Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. Aim: This study aimed to investigate CR utilisation and effectiveness in South Australia. Methods: This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. Results: Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23–79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01–1.24; p=0.024), depression (OR 1.17; 95% CI 1.05–1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05–1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31–0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58–0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73–0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). Conclusions: Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.

KW - Cardiac rehabilitation

KW - Clinical audit and effectiveness

KW - Quality improvement

UR - http://www.scopus.com/inward/record.url?scp=85186641331&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/NHMRC/1169893

U2 - 10.1016/j.hlc.2024.01.018

DO - 10.1016/j.hlc.2024.01.018

M3 - Article

AN - SCOPUS:85186641331

SN - 1443-9506

VL - 33

SP - 1036

EP - 1045

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

IS - 7

ER -

Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

ACvA CV Champion

Consumers' Choice Poster - Sponsored by The Heart Foundation

CSIRO On Prime Innovation Reward 2024

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

Global Impact and Recognition of the PROLIFERATE_AI Method

Dr. María Alejandra Piñero de Plaza Shares Insights on Her Research on Spanish Radio Program "Siempre Lunes"

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

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study

Effectiveness of alternative vs traditional exercises on cardiac rehabilitation program utilization in women with or at high risk of cardiovascular disease: a systematic review protocol

Cite this

Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Prizes

Activities

Research output

Cite this