Exclusive: GPs urged to offer rehab in heart risk standards

GPs must refer heart disease patients to cardiac rehabilitation run by a multidisciplinary team to improve long-term care and avoid hospital readmissions, under a major revision to UK standards.

Dr Knapton: 'Cardiac rehabilitation is probably the best evidence-based long-term condition management alongside diabetes'
Dr Knapton: 'Cardiac rehabilitation is probably the best evidence-based long-term condition management alongside diabetes'

Seven core standards set out by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) aim to improve uptake and quality of rehabilitation programmes in England.

Cardiac rehabilitation has been shown to cut hospital readmissions and improve quality of life for patients with heart disease.

Yet, an audit by the charity the British Heart Foundation (BHF) in November 2011 found that just 42% of eligible patients took part in a course in 2009/10.

Cambridgeshire GP Dr Mike Knapton, associate medical director at the BHF, urged GPs to refer all eligible patients and ensure they can access local programmes.

He said: 'Cardiac rehabilitation is probably the best evidence-based long-term condition management alongside diabetes.

'GPs can themselves make sure referral happens. They can find out where the nearest schemes are. They can follow up to make sure they know if the patient has attended, in the same way as with smoking cessation programmes.'

Commissioners urged to act
Dr Knapton added that GPs could help tackle the lack of access nationally by pressuring local clinical commissioning groups (CCGs) to improve services.

'CCGs must make sure there is suitable commissioning guidance. For those [GPs] in commissioning, they could make sure there is suitable capacity and quality of service.'

The BACPR standards update previous guidelines published in 2007. Patients, healthcare professionals and commissioners should expect the following from 'gold-standard' cardiac rehabilitation services:

  • The coordinated delivery of seven core components employing an evidence-based approach.
  • A multidisciplinary team consisting of professionally qualified staff, led by a clinical coordinator.
  • Identification, referral and recruitment of eligible patient populations.
  • Early initial assessment of individual patient needs in each of the core components, ongoing assessment and reassessment upon programme completion.
  • Early provision of a cardiac rehabilitation programme, with a defined pathway of care, which meets the core components and is aligned with patient preference and choice.
  • Registration and submission of data to the National Audit for Cardiac Rehabilitation.
  • Establishment of a business case including a cardiac rehabilitation budget which meets the full service costs.

Rehabilitation should be offered to all patients with heart conditions including acute coronary syndrome, stable angina, stable heart failure and atherosclerotic diseases such as TIA.

A programme typically includes sessions on health behaviour and education, diet, mitigating lifestyle risk factors such as poor diet and smoking, and psychosocial health.

GPSIs in cardiology are often involved in delivering these services, alongside physiotherapists, dieticians, psychologists and occupational therapists, among others. In some cases, GPs have set up their own programmes.

GPs could be paid to refer patients with prior MI to such programmes following proposals from NICE to add it to the QOF from April 2013.

The institute published a commissioning guide to cardiac rehabilitation services in April 2010.

 

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