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Heart attack patients missing out on vital rehab from nurses

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Thousands of heart patients are missing out on cardiac rehabilitation following a heart attack, reveal new figures released by the British Heart Foundation.

The charity’s National Audit of Cardiac Rehab found around 68,000 did not receive cardiac rehab in 2015-16. This represents nearly half – 48% – of those eligible for vital aftercare.

“This urgently needs to be addressed so that every patient has access to cardiac rehabilitation”

Simon Gillespie

The audit, combining data from England, Wales and Northern Ireland and overseen by the University of York, found people from deprived areas were less likely to engage with services compared with those in more affluent areas.

It also showed a worrying disparity in uptake among men and women, with 52% of eligible men taking part in a rehab programme compared to just 44% of women.

Meanwhile, those referred for cardiac rehabilitation often experienced delays, with 49% of heart attack and angioplasty patients having to wait longer than the recommended 28 days to start a rehab programme.

Cardiac rehab offers patients physical, emotional and lifestyle support including exercise classes and dietary advice and is generally delivered by multi-disciplinary teams, noted the charity.

The audit also showed that the vast majority of these teams included nurses, with 97% of the 234 cardiac rehab programmes across the UK employing nursing staff – 227 nurses in all.

“Cardiac rehab was absolutely vital for my recovery after my heart attack”

Laura Needham

Of the 200 programmes in England, 97% employed nurses while all 20 programmes in Wales have nurses on the team. Of the 11 programmes in Northern Ireland, all but one employs a nurse.

The British Association for Cardiovascular Prevention and Rehabilitation states teams should be made up of staff from three different disciplines to best serve patients.

However, the National Audit of Cardiac Rehabilitation Annual Statistical Report 2017 shows some teams across the UK have just one or two members of staff.

The British Heart Foundation welcomed the fact that more heart patients were accessing aftercare services – with uptake in the UK reaching more than 50% for the second year running.

But the charity warned that, because around half of eligible patients were not attending cardiac rehab, lives were being put at risk and avoidable pressure placed on an already stretched NHS.

Research has shown that participation in cardiac rehab reduces the risk of dying by 18% in the six to 12 months following referral and can cut readmissions to hospital by nearly a third – 31%.

Laura Needham, a nurse from Sheffield, experienced the difference programmes can make first-hand after she suffered a heart attack when she was just 32.

BHF chief executive

Simon Gillespie

Simon Gillespie

“Cardiac rehab was absolutely vital for my recovery after my heart attack. Both the physical and mental health support made such a difference in understanding how my body and my mind were affected, and what I could do to help myself,” she said.

“The nurses were reassuring and very knowledgeable – they helped me find strategies to cope if I was ever feeling low or physically unwell,” she said. “I would recommend it as an absolute must for anyone unfortunate enough to suffer a heart attack, there was no pressure – just support and advice.”

British Heart Foundation chief executive Simon Gillespie said it was “hugely encouraging” that more patients overall were receiving aftercare, but said the audit revealed worrying gaps and trends, including the fact significantly fewer women were accessing cardiac rehab.

“A postcode lottery of care is also evident with dangerous waiting times to access services in some areas of the country,” he said.

“This urgently needs to be addressed so that every patient has access to cardiac rehabilitation to improve their physical and mental wellbeing,” he added.

“More needs to be done to ensure that all programmes are meeting minimum standards”

Patrick Doherty

The report authors said it was vital to get a better understanding of patients’ preferences when it came to the delivery of cardiac rehab services and factors that may prevent them from enrolling.

In particular, they said the NHS should look at providing more home-based and online rehab programmes – as well as more community-based schemes – that people may find easier to access.

Programmes should also be tailored for different groups taking into account things like age, gender and ethnicity.

Overall, lead author Patrick Doherty, professor of cardiovascular health at the University of York, said more work was needed to ensure consistent levels of care.

“More needs to be done to ensure that all programmes are meeting minimum standards, ensuring everyone gets the care and advice they need and deserve following a heart attack,” he said.

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