Cardiac rehabilitation information for health professionals

Cardiac rehabilitation (cardiac rehab) is a personalised support, exercise and education program led by healthcare professionals to manage cardiovascular risk factors and assist in a patient’s recovery after a heart event or diagnosis.

It is recognised as one of the most cost-effective interventions to improve patient outcomes and for the secondary prevention of heart attack in many cardiovascular diseases.¹ 

The Heart Foundation strongly recommends that all Australians who experience a heart event are referred to and attend a cardiac rehabilitation program. Cardiac rehabilitation supports long-term lifestyle changes, helping Australians to live a longer and healthier life. 

What does cardiac rehabilitation involve? 

At the start of the program, a comprehensive assessment of an individual’s medical, physical, mental and emotional health is conducted. This is followed by goal-setting with the patient based on their baseline function and what they value and what their motivators are.  

Cardiac rehabilitation can be delivered in multiple settings (face to face, in hospital or community, online or over the phone).  

Each session of the program includes: 

• supervised and personalised physical activity session that is safely increased based on the patient’s function and goals 
• delivery of education about key heart health topics to support patient knowledge, self-management and risk-factor modification (e.g. medicine safety, nutrition and return to work tips) 
• the opportunity to ask questions and interact with others who are also participating in a cardiac rehabilitation program 

After the program, an assessment is conducted to reviews the patient’s progress toward their agreed goals and health status. Information is shared with their healthcare team and plans are made to support ongoing secondary prevention.  

Why should I refer my patients to cardiac rehabilitation?  

Recovery from a heart event, hospital admission or a heart diagnosis is challenging. Many patients struggle physically, socially and emotionally to return to a quality of life. Additionally, heart diseases are typically chronic and require lifelong management to reduce the risk of future events and to live well.  

Cardiac rehabilitation gives your patients support, guidance and intervention to assist them on their road to recovery and to thrive. Its benefits are well established. Cardiac rehabilitation gives your patients support, guidance and intervention to assist their recovery.  

Research has shown that cardiac rehabilitation can reduce disability and mortality, improve cardiac risk factor profile, reduce hospital readmissions and improve quality of life^2,3.  

Patients are 40% less likely to be readmitted to hospital and 25% less likely to die from another heart attack if they have participated in a cardiac rehabilitation program^4.  

In addition, patients report the following benefits of completing cardiac rehab:  

• gain in confidence to return to physical activity  
• understanding and knowledge to better manage their condition 
• provision of an emotionally supportive environment and reduced psychological distress 
• feeling less alone and more supported from sharing their experience of heart disease with other patients, especially when the program is delivered in person 

However, the Australian rates of referral and attendance of cardiac rehabilitation are low. In a recent Australian study of 49,000 patients eligible for cardiac rehabilitation, only 30% of patients were referred to cardiac rehabilitation and of these only 28% actually attended^5.  

Many patients leave the hospital without a conversation about the benefits of cardiac rehabilitation and a referral to their closest or most appropriate service. It’s important for health professionals in the hospital to discuss the benefits of cardiac rehabilitation and endorse its merits with patients.  

How does the Heart Foundation support cardiac rehabilitation? 

The Heart Foundation pioneered the introduction of cardiac rehabilitation in Australia in 1961. Since then we have supported and advocated for investment in cardiac rehabilitation and its promotion to improve the quality of life of Australians.  

The Heart Foundation has created several resources to support healthcare professionals to promote and deliver cardiac rehab, including: 

National Cardiac Rehabilitation Quality Indicators

Quality indicators are explicitly defined statements that aim to measure adherence to aspects of evidence-based care that are deemed necessary for reaching optimal patient outcomes and provide a basis for quality improvement projects.

Download National Cardiac Rehabilitation Quality Indicators

Download Evaluation of Cardiac RehabilitationPerformance and Initial Benchmarks forAustralia: An Observational Cross-Stateand Territory Snapshot Study

A Pathway to Phase II Cardiac Recovery (Full Resource)	Download PDF
Module 1: Initial assessment and goal setting	Download PDF
Module 2: Heart education and self-management	Download PDF
Module 3: Medication education and review	Download PDF
Module 4: Managing medical risk factors	Download PDF
Module 5: Exercise training	Download PDF
Module 6: Healthy eating and weight management	Download PDF
Module 7: Tobacco cessation and alcohol reduction	Download PDF
Module 8: Psychosocial health Psychosocial well being	Download PDF
Module 9: Activities of daily living	Download PDF
Module 10: Reassessment and completion	Download PDF
A Quick Guide Checklist of the Pathway to Cardiac Recovery	Download PDF

Advocacy resources 

The Advocacy Toolkit has been developed to support health professionals promote improved cardiac rehabilitation and heart failure services in their local area. The Toolkit includes two factsheets outlining the evidence that shows the benefits of cardiac rehabilitation and heart failure services.

The Heart Foundation has developed this Toolkit with the support of the Statewide Cardiac Clinical Network and the AMA Queensland. 

The Advocacy Toolkit 

Cardiac rehabilitation factsheet	Download PDF
Heart failure factsheet	Download PDF
ACRA Core Components of Cardiovascular Disease Secondary Prevention and Cardiac Rehabilitation 2014	Link to
Improving the delivery of cardiac rehabilitation in Australia, 2014 (PDF)  The Heart Foundation’s cardiac rehabilitation advocacy strategy	Download PDF

Cardiac Rehabilitation consumer page contains information, educational videos and resources for patients to better understand what is offered in a cardiac rehabilitation program and the importance of attendance. 

Cardiac Services Directory provides an interactive service map allowing the user to search for the closest cardiac rehabilitation program by postcode to make an appropriate referral. 

The Heart Foundation Helpline on 13 11 12 will help you find the most appropriate cardiac rehabilitation service for your patients. 

References

1 https://journals.sagepub.com/doi/full/10.1177/2047487320913379

2 https://journals.sagepub.com/doi/full/10.1177/2047487320913379 

3 https://pubmed.ncbi.nlm.nih.gov/26442971/ 

4 De Grutyer et al, Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services – A Cost Benefit Analysis, Heart Lung Circ. 2016 Feb:25(2)175-83.

5.The Impact of Cardiac Rehabilitation and Secondary Prevention Programs on 12-Month Clinical Outcomes: A Linked Data Analysis https://pubmed.ncbi.nlm.nih.gov/31072769/